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Utilization Review Rn Jobs in Virginia (NOW HIRING)

GQR

RN - Case Manager

Charlottesville, VA · On-site

$1.8K - $1.9K/wk

  • Medical

  • Dental

  • Vision

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Charlottesville, Virginia Start Date: August 17, 2026 Profession: Registered Nurse (RN) Facility: Hospital ...

GQR Healthcare

Travel Case Manager

Chesapeake, VA · On-site

$2.1K - $2.2K/wk

  • Medical

  • Dental

  • Vision

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Chesapeake, Virginia Start Date: August 31, 2026 Profession: Registered Nurse (RN) Facility: Hospital ...

GQR Healthcare

Travel Case Manager

Chesapeake, VA · On-site

$2.0K - $2.1K/wk

  • Medical

  • Dental

  • Vision

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Chesapeake, Virginia Start Date: August 31, 2026 Profession: Registered Nurse (RN) Facility: Hospital ...

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... or RN or current clinical professional license or certification, as required, within the state ...

Summit BHC

Utilization Specialist - Acute

Williamsburg, VA · On-site

$24 - $28/hr

  • Medical

  • Dental

  • Vision

  • PTO

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... or RN or current clinical professional license or certification, as required, within the state ...

Lifepoint Health

RN Director Case Management

Danville, VA · On-site

$83K - $112K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Our collaborative approach to safe, effective discharge planning includes close coordination between a Utilization Review RN, Case Manager RN, and Social Worker-ensuring each patient receives ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Virginia

Utilization Review Rn information

See Virginia salary details

$21

$41

$68

How much do utilization review rn jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for utilization review rn in Virginia is $41.92, according to ZipRecruiter salary data. Most workers in this role earn between $33.12 and $48.12 per hour, depending on experience, location, and employer.

How does a utilization review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

What are the key skills and qualifications needed to thrive as a utilization review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

How to get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or knowledge of medical coding and insurance processes can enhance your qualifications. Gaining experience in case management or health insurance companies can also improve your chances of entering the field.

What is the difference between Utilization Review Rn vs Case Manager?

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

What is a utilization review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are the most commonly searched types of Utilization Review Rn jobs in Virginia? The most popular types of Utilization Review Rn jobs in Virginia are:
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What job categories do people searching Utilization Review Rn jobs in Virginia look for? The top searched job categories for Utilization Review Rn jobs in Virginia are:
What cities in Virginia are hiring for Utilization Review Rn jobs? Cities in Virginia with the most Utilization Review Rn job openings:
What are popular job titles related to Utilization Review Rn jobs in VA? For Utilization Review Rn jobs in VA, the most frequently searched job titles are:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Virginia as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 12% Part Time, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $87,192 per year, or $41.9 per hour.

RN Case Manager - Utilization Management - Part Time

Augusta Medical Center

Fishersville, VA • On-site

$35.43 - $54.21/hr

Part-time

Medical, Retirement, PTO

Posted 7 days ago

Job description

The Utilization Review RN Case Manager applies knowledge of medical necessity criteria and regulatory requirements in determining the appropriate patient status for any person destined for a bed on the patient care units. This position works closely with admitting and attending providers as well as the Utilization Management Physician Advisor to ensure patient status is accurate and compliant with regulatory standards. The Utilization Review RN Case Manager is viewed by clinical teams as an expert in the building when it comes to selecting the appropriate level of service for patients. They participate in multidisciplinary discharge rounds on the hospital units to understand clinical course, discharge plans and possible changes in medical necessity, all toward selecting the levels of care that match clinical necessity. This position plays an essential role in securing reimbursement to the hospital for services provided by commercial, Medicaid and Medicare payers through timely communication and submission of relevant clinical information to the payer when required. The effective tending of utilization review lowers the frequency of avoidable denials by payers for services provided. This role ensures adherence to the policies and guidelines of all payer review organizations to secure appropriate reimbursement for patient hospitalizations. During normal business hours this position may screen patients to determine if case management follow-up is required.

Minimum Qualifications

  • Bachelor of Science in Nursing
    OR
  • Associate’s degree in Nursing PLUS three years of experience as an RN
  • Registered nurse license in the Commonwealth of Virginia or from a state that is part of a compact agreement with Virginia
  • Acute care hospital experience or comparable job-related experience in at least 3 of the last 5 years

Preferred Qualifications

  • National certification in case management or utilization management preferred
  • 3 to 5 years of recent experience in utilization review and/or discharge planning in an acute care setting preferred

Skills

  • Comprehensive knowledge of regulatory, legislative, and DNV standards related to utilization review.
  • Proficient in computer skills including navigating EHRs, medical necessity criteria, Microsoft Office products.
  • Effective verbal and written skills with the ability to collaborate with multiple disciplines throughout the organization.
  • Good problem solving and decision-making skills.
  • Excellent organizational skills and the ability to work in a fast-paced environment.

Some benefits of working at Augusta Health include

  • Healthcare Benefits
  • Generous paid time off
  • Retirement savings helping you to plan for your future
  • Free onsite parking
  • 24/7 armed security to ensure your safety
  • Tuition reimbursement
  • Onsite child care
  • Augusta Health Fitness Reimbursement Program
  • Onsite credit union
  • Employee discounts including the cafeteria, gift shop, pharmacy, and movie tickets

Company Information

Augusta Health is a mission-driven, independent, nonprofit, community health system located in Fishersville Virginia in Virginia’s scenic Shenandoah Valley. Augusta Health offers a full continuum of inpatient and outpatient which includes Augusta Medical Center a 255 bed inpatient facility and Augusta Medical Group which is comprised of 40 practice locations and four urgent care locations.

Equal Opportunity

Augusta Health recruits, hires and promotes qualified candidates for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran or military discharge status, and family medical or genetic information.

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