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 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 ...
Our REACH team is growing and searching for our next Utilization and Training Specialist! In this position, you will ensure all utilization management and training processes are completed as needed ...
Our REACH team is growing and searching for our next Utilization and Training Specialist! In this position, you will ensure all utilization management and training processes are completed as needed ...
Our REACH team is growing and searching for our next Utilization and Training Specialist! In this position, you will ensure all utilization management and training processes are completed as needed ...
Our REACH team is growing and searching for our next Utilization and Training Specialist! In this position, you will ensure all utilization management and training processes are completed as needed ...
... review and respond to concerns expressed by customers. Together with the appropriate Department ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...
... review and respond to concerns expressed by customers. Together with the appropriate Department ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...
Director of Utilization Management
Danville, VA · On-site
$79K - $95K/yr
Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ... or LCP in Virginia required. EEO Statement All UHS subsidiaries are committed to providing an ...
Director of Utilization Management
Danville, VA · On-site
$79K - $95K/yr
Three to five years of experience in utilization review and case management. RN, LCSW, LPC, LMFT, ... or LCP in Virginia required. EEO Statement All UHS subsidiaries are committed to providing an ...
UR 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 ...
UR 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 ...
Click here to review the benefits associated with this position. Aetna is an equal opportunity ... preferred Utilization Manager experience preferred Previous Managed Care experience preferred ...
Click here to review the benefits associated with this position. Aetna is an equal opportunity ... preferred Utilization Manager experience preferred Previous Managed Care experience preferred ...
Click here to review the benefits associated with this position. Aetna is an equal opportunity ... preferred Utilization Manager experience preferred Previous Managed Care experience preferred ...
Click here to review the benefits associated with this position. Aetna is an equal opportunity ... preferred Utilization Manager experience preferred Previous Managed Care experience preferred ...
Anesthesiology Physician
Suffolk, VA · On-site
$380K/yr
Provide education to physicians, leaders, and staff regarding utilization review, documentation integrity, and regulatory requirements. * Complete required training and continuing education.
Anesthesiology Physician
Suffolk, VA · On-site
$380K/yr
Provide education to physicians, leaders, and staff regarding utilization review, documentation integrity, and regulatory requirements. * Complete required training and continuing education.
Provide education to physicians, leaders, and staff regarding utilization review, documentation integrity, and regulatory requirements. * Complete required training and continuing education.
Provide education to physicians, leaders, and staff regarding utilization review, documentation integrity, and regulatory requirements. * Complete required training and continuing education.
Provide education to physicians, leaders, and staff regarding utilization review, documentation integrity, and regulatory requirements. * Complete required training and continuing education.
Provide education to physicians, leaders, and staff regarding utilization review, documentation integrity, and regulatory requirements. * Complete required training and continuing education.
Physician Advisor, Physician Advisor - Sentara Virginia Beach General Hospital
Virginia Beach, VA · On-site
Provide education to physicians, leaders, and staff regarding utilization review, documentation integrity, and regulatory requirements. * Complete required training and continuing education.
Physician Advisor, Physician Advisor - Sentara Virginia Beach General Hospital
Virginia Beach, VA · On-site
Provide education to physicians, leaders, and staff regarding utilization review, documentation integrity, and regulatory requirements. * Complete required training and continuing education.
Provide education to physicians, leaders, and staff regarding utilization review, documentation integrity, and regulatory requirements. * Complete required training and continuing education.
Provide education to physicians, leaders, and staff regarding utilization review, documentation integrity, and regulatory requirements. * Complete required training and continuing education.
Provide education to physicians, leaders, and staff regarding utilization review, documentation integrity, and regulatory requirements. * Complete required training and continuing education.
Provide education to physicians, leaders, and staff regarding utilization review, documentation integrity, and regulatory requirements. * Complete required training and continuing education.
Administrative position focused on utilization review and medical necessity* Conduct medical necessity reviews and ensure compliant hospital status and billing* Lead denials management including peer ...
Administrative position focused on utilization review and medical necessity* Conduct medical necessity reviews and ensure compliant hospital status and billing* Lead denials management including peer ...
RN - Case Manager
Chesapeake, VA · On-site
$2.0K - $2.1K/wk
Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Chesapeake, Virginia Start Date: August 31, 2026 Profession: Registered Nurse (RN) Facility: Hospital Estimated ...
RN - Case Manager
Chesapeake, VA · On-site
$2.0K - $2.1K/wk
Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Chesapeake, Virginia Start Date: August 31, 2026 Profession: Registered Nurse (RN) Facility: Hospital Estimated ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as ...
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 ...
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 ...
RN Case Manager
Chesapeake, VA · On-site
$2.1K - $2.2K/wk
Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Chesapeake, Virginia Start Date: September 14, 2026 Profession: Registered Nurse (RN) Facility: Hospital Estimated ...
RN Case Manager
Chesapeake, VA · On-site
$2.1K - $2.2K/wk
Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Chesapeake, Virginia Start Date: September 14, 2026 Profession: Registered Nurse (RN) Facility: Hospital Estimated ...
Utilization Review information
See Virginia salary details
$21.21 - $25.50
2% of jobs
$25.50 - $29.79
9% of jobs
$32.73 is the 25th percentile. Wages below this are outliers.
$29.79 - $34.08
21% of jobs
The median wage is $37.55 / hr.
$34.08 - $38.37
23% of jobs
$38.37 - $42.66
13% of jobs
$46 is the 75th percentile. Wages above this are outliers.
$42.66 - $46.95
10% of jobs
$46.95 - $51.24
8% of jobs
$51.24 - $55.53
5% of jobs
$55.53 - $59.82
5% of jobs
$59.82 - $64.11
2% of jobs
$64.11 - $68.40
2% of jobs
$21
$41
$68
How much do utilization review jobs pay per hour?
As of Aug 24, 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:
- Overnight Utilization Review Nurse
- No Experience Hedis Review Nurse
- Part Time Utilization Review Nurse
- Remote Utilization Review Nurse
- Evening Utilization Review Nurse
- Flex Schedule Remote Utilization Review Nurse
- No Experience Utilization Management Nurse
- Night Shift Remote Utilization Review Nurse
- Temporary Utilization Review Nurse
- Per Diem Remote Chart Review Nurse
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:
- Review Nurse
- Director Of Utilization Review
- Therapy Utilization Review
- Remote Aetna Utilization Review Nurse
- Remote Cigna Utilization Review Nurse
- Medical Utilization Review Physician
- Authorization Utilization Review Bcba
- Anthem Utilization Review Nurse
- Fulltime Cigna Utilization Review Nurse
- Utilization Review Manager
What cities in Virginia are hiring for Utilization Review jobs?
Cities in Virginia with the most Utilization Review job openings:
Part-time
Medical, Retirement, PTO
Posted 19 days ago
Augusta Health rating
6.6
Based on 47 frontline employees who took The Breakroom Quiz
682nd of 1,062 rated hospitals
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
Preferred Qualifications
Skills
Some benefits of working at Augusta Health include
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.
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.
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.
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.
What Augusta Health employees say
Pay
Benefits
Hours and flexibility
Workplace
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About Augusta Health
Sourced by ZipRecruiter
Company size
1,001 - 5,000 Employees
Headquarters location
Fishersville, VA, US
Year founded
1994