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Utilization Review Jobs in Virginia (NOW HIRING)

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

... Utilization Review Reports as necessary. · Coordinates and makes Retrospective Appeals to third party payers. · Meets weekly with Administrator on appropriate issues. · Other duties as assigned ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA

... Utilization Review Reports as necessary. · Coordinates and makes Retrospective Appeals to third party payers. · Meets weekly with Administrator on appropriate issues. · Other duties as assigned ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA

... Utilization Review Reports as necessary. · Coordinates and makes Retrospective Appeals to third party payers. · Meets weekly with Administrator on appropriate issues. · Other duties as assigned ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA

... Utilization Review Reports as necessary. · Coordinates and makes Retrospective Appeals to third party payers. · Meets weekly with Administrator on appropriate issues. · Other duties as assigned ...

UHS

UTILIZATION REVIEW COORDINATOR

Danville, VA · On-site

$26 - $35/hr

... Utilization Review Reports as necessary. • Coordinates and makes Retrospective Appeals to third party payers. • Meets weekly with Administrator on appropriate issues. • Other duties as assigned ...

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

$60 - $80/hr

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which ...

Summit BHC

Utilization Specialist

Williamsburg, VA · On-site

The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays, utilization practices and discharge planning according to approved clinically valid criteria which ...

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All JobsUtilization Review JobsUtilization Review Jobs in Virginia

Utilization Review information

See Virginia salary details

$21

$41

$68

How much do utilization review jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for utilization review 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.

What is a utilization review?

A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.

What does a utilization review do?

A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.

What are the key skills and qualifications needed to thrive in utilization review?

To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, like the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects, and strong analytical and communication skills are essential for success in the role.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on work environment and individual coping skills.

What are the most commonly searched types of Utilization Review jobs in Virginia?

The most popular types of Utilization Review jobs in Virginia are:

What are popular job titles related to Utilization Review jobs in Virginia?

For Utilization Review jobs in Virginia, the most frequently searched job titles are:

What job categories do people searching Utilization Review jobs in Virginia look for?

The top searched job categories for Utilization Review jobs in Virginia are:

What cities in Virginia are hiring for Utilization Review jobs?

Cities in Virginia with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Virginia as of August 2026, with employment types broken down into 100% Full Time. Highlights an 94% In-person, and 6% Remote job distribution, with an average salary of $87,192 per year, or $41.9 per hour.

UTILIZATION REVIEW NURSE

Sentara Health Administration, Inc.

Norfolk, VA • On-site

$75 - $105/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 5 days ago

Job description

City/StateNorfolk, VAWork ShiftFirst (Days)Overview:Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse.The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, care coordination for appropriateness of treatment, set reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts.Responsible for written and/or verbal notification to members and providers. Ensures medical director 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:· BSN (preferred)Certification:· Registered Nurse (required)Experience:· 3 years of acute care clinical experience (required)· Previous Utilization Review experience (preferred)· Milliman experience (preferred)· Knowledge of NCQA (preferred)· Microsoft suite (Word, Excel, Outlook) (preferred)· Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skillsKeywords: Talroo- Health, Utilization Review Nurse, RN, Care Coordination, or Discharge Planning, Case Management, Milliman, NCQABenefits: 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 if established 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. #J-18808-Ljbffr

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