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Utilization Review Rn Jobs in Virginia (NOW HIRING)

VHS Hospice

RN Case Manager

Newport News, VA

$70K - $95K/yr

Previous case management or utilization review experience preferred. * Direct patient care ... Benefits for RN Case Manager: * Tuition reimbursement * Employee referral bonus * Health, vision ...

Astyra Corporation

Clinical Auditor, RN

Glen Allen, VA · Hybrid

$40 - $44/hr

Minimum three years of clinical documentation review experience, utilization management review ... Current Registered Nurse (RN) license in good standing * Certified Professional / Hospital Coder ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Virginia

Utilization Review Rn information

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$41

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How much do utilization review rn jobs pay per hour?

As of Jul 24, 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 to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

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 make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

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.

How to make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

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 cities in Virginia are hiring for Utilization Review Rn jobs? Cities in Virginia with the most Utilization Review Rn job openings:
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Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Virginia as of July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, and 3% Contract. Highlights an 91% Physical, 3% Hybrid, and 6% Remote job distribution, with an average salary of $87,192 per year, or $41.9 per hour.

RN Case Manager

VHS Hospice

Newport News, VA

$70K - $95K/yr

Other

Medical, Dental, Vision, Life, Retirement

Posted 21 days ago

Job description

Join our team at VHS Hospice as an RN Case Manager

Proudly supported by Marquis Health

  • Full-time, part-time and PRN available!

  • Same Day Pay!  

  • Locations include: Hampton, Newport News, Williamsburg, Norfolk and Virginia Beach

Proudly supported by Marquis Health Consulting Services

$70,000.00-$95,000.00/annual (all inclusive)

At VHS Hospice, we believe that coordinated, compassionate, and patient-centered care is essential to achieving the best possible outcomes for our residents. Guided by our core values of Passion, Respect, and Excellence, the RN Case Manager plays a key role in overseeing care coordination, supporting clinical decision-making, and ensuring continuity of care across the healthcare continuum.

Responsibilities for RN Case Manager:

  • Coordinate and manage care for patients with chronic, acute, or complex medical conditions across the care continuum.

  • Conduct comprehensive patient assessments to identify physical, psychosocial, and environmental needs.

  • Develop, implement, and continuously evaluate individualized care plans in collaboration with interdisciplinary healthcare teams.

  • Monitor patient progress toward established goals and adjust care plans based on clinical outcomes and changing needs.

  • Serve as a patient advocate by ensuring the resident's needs, goals, and preferences are communicated and respected throughout the care process.

  • Facilitate communication between patients, families, physicians, and healthcare providers to ensure continuity and quality of care.

  • Coordinate medical appointments, referrals, transportation, and access to community resources as needed.

  • Ensure efficient and appropriate utilization of healthcare resources while maintaining high-quality care standards.

  • Provide education to patients and families regarding diagnoses, treatment options, and care planning.

Qualifications for RN Case Manager:

  • Minimum of an RN Associate’s Degree in Nursing (ADN) required; Bachelor of Science in Nursing (BSN) preferred.

  • Previous case management or utilization review experience preferred.

  • Direct patient care experience strongly preferred.

  • Strong communication, negotiation, and problem-solving skills.

  • Solid understanding of healthcare regulations, standards of practice, and care coordination principles.

Our Core Values in Action

Passion – Advocating for residents to receive timely, appropriate, and compassionate care that meets their individual needs.

Respect – Honoring patient preferences, dignity, and autonomy throughout the care planning and coordination process.

Excellence – Ensuring high-quality, efficient, and well-coordinated care through strong clinical judgment and collaboration.

Benefits for RN Case Manager:

  • Tuition reimbursement

  • Employee referral bonus

  • Health, vision, and dental benefits

  • 401(k) with match

  • Employee engagement and culture committee

  • Shift differentials

  • Company-sponsored life insurance

  • Employee assistance program (EAP) resources

Join our team at VHS Hospice, where compassion and quality care are at the heart of everything we do. Our facility is thoughtfully designed with beautiful common spaces, creating a welcoming, home-like environment not only for our residents but also for our staff. We believe in fostering a positive and supportive workplace where employees feel valued, respected, and empowered to make a difference.

Here, you'll be part of a collaborative and dedicated team that prioritizes professional growth, work-life balance, and a culture of appreciation. If you're passionate about providing exceptional care in a warm, inclusive setting, we would love for you to grow your career with us.

The facility provides equal employment opportunities to all applicants and employees and prohibits discrimination and harassment of any kind. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by federal, state, or local law. All qualified applicants are encouraged to apply.