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Utilization Review Rn Jobs in Hampton, VA (NOW HIRING)

GQR Global Markets

RN Case Manager

Williamsburg, VA · On-site

$1.9K - $1.9K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Williamsburg, Virginia Start Date: August 24, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay ...

New

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 ...

Lancesoft INC

RN Case Manager

Chesapeake, VA · On-site

$2.3K - $2.4K/wk

Preferred License: Active Compact or Virginia RN license (Must be in hand - no exceptions ... Discharge planning Utilization Review (UR) Experience in fast-paced surgical units EPIC charting ...

Sentara

Registered Nurse (RN)

Virginia Beach, VA · On-site

$10K/mo

... utilization, and environmental health) encompass the actions and foundation of professional nursing. The RN possesses clinical knowledge and skills to meet standards as required by specific clinical ...

Sentara

Registered Nurse (RN)

Norfolk, VA · On-site

$10K/mo

... utilization, and environmental health) encompass the actions and foundation of professional nursing. The RN possesses clinical knowledge and skills to meet standards as required by specific clinical ...

Sentara

Registered Nurse RN

Virginia Beach, VA

$10K/mo

... utilization, and environmental health) encompass the actions and foundation of professional nursing. Education: * ADN required, BSN or higher preferred. Certification: * Virginia or compact ...

Sentara

Registered Nurse (RN)

Norfolk, VA · On-site

$10K/mo

... utilization, and environmental health) encompass the actions and foundation of professional nursing. The RN possesses clinical knowledge and skills to meet standards as required by specific clinical ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Hampton, VA

Utilization Review Rn information

See Hampton, VA salary details

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How much do utilization review rn jobs pay per hour?

As of Aug 17, 2026, the average hourly pay for utilization review rn in Hampton, VA is $40.86, according to ZipRecruiter salary data. Most workers in this role earn between $32.31 and $46.92 per hour, depending on experience, location, and employer.

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.

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.

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 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 case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

What are popular job titles related to Utilization Review Rn jobs in Hampton, VA?

For Utilization Review Rn jobs in Hampton, VA, the most frequently searched job titles are:

What job categories do people searching Utilization Review Rn jobs in Hampton, VA look for?

The top searched job categories for Utilization Review Rn jobs in Hampton, VA are:

What cities near Hampton, VA are hiring for Utilization Review Rn jobs?

Cities near Hampton, VA with the most Utilization Review Rn job openings:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Hampton, VA as of August 2026, with employment types broken down into 1% As Needed, 72% Full Time, 24% Part Time, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $84,995 per year, or $40.9 per hour.

Utilization Review Nurse / RN for Medicaid - Remote

Sentara Health

Norfolk, VA • Remote

$66K - $111K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

New

Sentara Health rating

6.7

Company rating: 6.7 out of 10

Based on 412 frontline employees who took The Breakroom Quiz

531st of 887 rated healthcare providers

Job description

City/State
Norfolk, VA
Work Shift
First (Days)
Overview:
Sentara Health Plansis hiring an Utilization Review Nurse/ RN for Medicaid - Remote!
Status: Full-time,permanent position (40 hours)

Standard working hours: 8am to 5pm EST, M-F. Weekend and holiday coverage required. Nurses participate in a self-scheduling process and are expected to work 13 weekend day shifts per year, as well as assigned holiday coverage.
Remote opportunities available in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, Wyoming
Job responsibilities:
  • Utilization Review Nurse is responsible for utilizing management services within the scope of licensure. Conducts primary functions of prior authorization, inpatient review, concurrent review, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conduct pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. May manage appeals for services denied. Responsible for written and/or verbal notification to members and providers. Demonstrates proactive anticipatory discharge planning; serves as joint transition of care coordinator with case management and facilitates member care transition. Ensures medical director's written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

Education:
  • Bachelors Degree in Nursing preferred

Certification/Licensure
  • Registered Nurse (RN) License (Compact or Virginia) REQUIRED

Preferred qualifications:
  • 3 years of acute care clinical experience REQUIRED
  • Previous Utilization Review highly preferred
  • Previous LTSS Waiver OR Medicaid experience highly preferred
  • InterQual or Milliman experience preferred.
  • Knowledge of NCQA preferred.
  • Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
  • Strong Microsoft skills (Word, Excel, Outlook and Teams).

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.
Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.
We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services-all to help our members improve their health.
We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is: $66,830.4 - $111,384. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-104382
Talroo - Nursing
Utilization, Review, Registered Nurse, BSN, ADN, Nursing, Managed Care, MCO, Health Plan, Virginia, RN, VA, Medicaid, Inpatient, irginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington (state), West Virginia, Wisconsin, Wyoming
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - $10,000
•Pet Insurance
•Legal Resources Plan
•Colleagues have the opportunity to earn an annual discretionary bonus ifestablished system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission “to improve health every day,” this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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