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

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 ...

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 ...

Sentara

Registered Nurse (RN)

Virginia Beach, VA

$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

$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

$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)

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

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 ...

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

Utilization Review Rn information

See Hampton, VA salary details

$20

$40

$66

How much do utilization review rn jobs pay per hour?

As of Jul 26, 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.

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 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 July 2026, with employment types broken down into 1% As Needed, 85% Full Time, 11% Part Time, 1% Temporary, and 2% Contract. 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 Specialist (Flexi)

Utilization Review Specialist (Flexi)

Chesapeake Regional Healthcare

Chesapeake, VA • On-site

Part-time

Medical

Posted 19 days ago

Chesapeake Regional Healthcare rating

6.9

Company rating: 6.9 out of 10

Based on 22 frontline employees who took The Breakroom Quiz

Job description

Summary
The Utilization Review Specialist supports the organization's utilization management program by conducting routine admission, concurrent, and retrospective reviews utilizing established screening criteria and organizational guidelines. This position collects, reviews, and documents clinical information to support medical necessity determinations and appropriate resource utilization. Complex, high-risk, or ambiguous cases requiring clinical judgment are referred to a RN Utilization Review for review and determination.
Essential Duties and Responsibilities
These duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned.
  • Conduct routine utilization reviews using approved screening criteria, established workflows, and departmental guidelines.
  • Collect and organize clinical documentation necessary to support utilization review activities.
  • Review patient records to identify required information for admission, continued stay, and discharge planning processes.
  • Apply established criteria to routine cases and document findings in designated systems.
  • Monitor assigned cases for required documentation and timely review completion.
  • Communicate with providers, clinical staff, payers, and care team members to obtain necessary information.
  • Identify cases that do not clearly meet established criteria and escalate them to an RN Utilization Review.
  • Present complex, high-acuity, disputed, or clinically ambiguous cases to an RN Utilization Review Specialist for evaluation and determination.
  • Assist with obtaining payer authorizations and tracking authorization status as directed.
  • Maintain accurate utilization management records, reports, and audit documentation.
  • Support denial prevention efforts through timely documentation and communication.
  • Participate in quality improvement initiatives related to utilization management processes.
  • Maintain knowledge of applicable payer requirements, regulatory standards, and organizational policies.
  • Assist with data collection and reporting related to utilization management metrics.
  • Perform other utilization management support duties within the scope of licensure and training.

Supervisory Responsibilities
Reports to: RN Clinical Doc Manager
Supervises: n/a
Responsibilities: n/a
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and Experience
Minimum Required Education:
Graduate of an approved healthcare program leading to licensure as a healthcare professional i.e. Licensed Practical Nurse (LPN) or other clinically licensed healthcare professionals as approved by the organization.
Experience:
Two (2) years of clinical healthcare experience required. Experience in utilization review, utilization management, case management, care coordination, discharge planning, or other related clinical healthcare functions may be considered.
Certificates, Licenses, Registrations:
Current unrestricted license as a Licensed Practical Nurse required at minimum in the Commonwealth of Virginia or compact state. Candidates possessing a higher level of clinical licensure are also eligible for consideration.
Certification in utilization management or case management preferred.
Physical Demands & Work Environment
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.
For further information, please review the Know Your Rights notice from the Department of Labor.

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