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Utilization Reviewer Jobs in Virginia (NOW HIRING)

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 ...

UHS

UTILIZATION COORDINATOR

Danville, VA

... review and respond to concerns expressed by customers. Together with the appropriate Department ... · Assist in preparing Utilization Review Reports as necessary. · Coordinates and makes ...

UHS

Director of Utilization Management

Danville, VA · On-site

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 ...

UHS

UR 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 ...

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Utilization Reviewer information

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$30.7K

$37.7K

$43.6K

How much do utilization reviewer jobs pay per year?

As of May 30, 2026, the average yearly pay for utilization reviewer in Virginia is $37,666.00, according to ZipRecruiter salary data. Most workers in this role earn between $33,700.00 and $41,600.00 per year, depending on experience, location, and employer.

What Does a Utilization Reviewer Do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

What are the key skills and qualifications needed to thrive as a Utilization Reviewer, and why are they important?

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.

How does a Utilization Reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What jobs make $3,000 a month without a degree?

Utilization reviewers typically earn between $3,000 and $4,500 per month, depending on experience and location, and often do not require a degree. Many related roles in healthcare or insurance involve reviewing claims or data, with some positions offering on-the-job training and certifications. Other jobs that can pay around $3,000 monthly without a degree include administrative assistants, sales representatives, and certain skilled trades, though wages vary by region and industry standards.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

More about Utilization Reviewer jobs
What are popular job titles related to Utilization Reviewer jobs in Virginia? For Utilization Reviewer jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Utilization Reviewer jobs in Virginia look for? The top searched job categories for Utilization Reviewer jobs in Virginia are:
What cities in Virginia are hiring for Utilization Reviewer jobs? Cities in Virginia with the most Utilization Reviewer job openings:
What are popular job titles related to Utilization Reviewer jobs in VA? For Utilization Reviewer jobs in VA, the most frequently searched job titles are:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Virginia as of May 2026, with employment types broken down into 83% Full Time, and 17% Contract. Highlights an 100% In-person job distribution, with an average salary of $37,666 per year, or $18.1 per hour.
RN Utilization Review (Flexi)

RN Utilization Review (Flexi)

Chesapeake Regional Healthcare

Chesapeake, VA • On-site

Part-time

Posted 12 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

Position Summary
The Utilization Review Nurse combines clinical expertise with knowledge of medical appropriateness criteria and applies principles of utilization and quality management, and the management of clinical/financial resources as a facilitator and consultant to the multidisciplinary patient care team. The Utilization Review Nurse is responsible for review of clinical information documented from providers ensuring clinical data is substantial enough to meet medical necessity criteria and will facilitate the appropriate billing status.
Duties and Responsibilities
The duties and responsibilities described below represent the general tasks performed on a daily basis; other tasks may be assigned.
General Responsibilities
  • Demonstrates the knowledge base and essential psychomotor skills required to effectively carry out the job.
  • Demonstrates the ability to interpret, analyze, and apply relevant data to prioritize and determine a course of action appropriate to meet the patients' clinical needs.
  • Demonstrates effective communication and collaboration with culturally and professional interpersonal skills.
  • Demonstrates effective time management and the initiative to carry out job responsibilities in a timely manner.
  • Effectively assess, plans, implements and evaluates strategies that ensure the appropriate utilization of clinical resources and management of length of stay.
  • Meets all organizational requirements. Demonstrates initiative to establish and achieve personal and professional goals.
  • Demonstrates effective customer service behaviors as defined by the organization's mission, vision and values.
  • Attend required hospital-wide orientations, meetings, and in-services.
  • Demonstrate a commitment to flexible work scheduling when necessary to ensure patient care.

Utilization Review / Clinical Responsibilities
  • Using approved criteria, conduct admission and concurrent chart reviews for Medicare, Medicaid, and managed care payers within appropriate time frame to ensure appropriateness of level of care.
  • Refers cases failing inpatient medical necessity screening to physician advisor for level of care determination when indicated.
  • Monitor length of stay and other ancillary resource use on an ongoing basis. Identify opportunities for process improvement and recommend actions. Monitor and document on an ongoing basis avoidable days.
  • Communicates following the chain of command regarding proper utilization of resources, physician concerns, and length of stay activities.
  • Coordinate with the department in-house liaison to assure third party certifications when required. Provide information as required regarding denials/approvals. Expedite the peer-to-peer process through collaboration with physicians and insurance companies.
  • Communicate denials, verbally and in writing, to patients, family, and physician as needed.
  • Interacts with patients and families to educate about level of care when necessary or indicated.
  • Delivers observation notices and notices of non-coverage as appropriate to beneficiaries.
  • Works with the interdisciplinary team to communicate level of care determinations.
  • On a concurrent basis, enter all pertinent data (UR and other areas as assigned) in data collection systems as per policy and established processes.
  • Participates in clinical performance improvement activities as needed and as assigned.
  • Works within the CMSA standards of practice.
  • Ensures compliance with CMS, State, and other regulatory agencies.
  • Liaison between attending physician and physician advisor for level of care recommendations, order changes, etc.
  • Assess for appropriate unit of care delivery within the hospital and make recommendations to the treating physician.
  • Works with Revenue Integrity, HIM, and other internal departments to ensure billing status is correct.
  • Employee must be proficient in his/her job responsibilities at the end of 90 days.

Reporting Relationships
  • Reports to: Director of Care Management
  • Supervises: None
  • 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
  • Minimum Required Education: RN degree required
  • Preferred Education: BSN preferred

Experience
  • Greater than 3 years clinical nursing experience required.
  • Utilization management experience preferred.
  • Must be self-directed and possess critical thinking and excellent organizational skills.

Certificates, Licenses, Registrations
CM certification strongly desirable. CCM or ACM or any approved certification body required within 2 years of eligibility for the exam
Physical Demands and 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.
A separate sheet documenting the description of physical demands and working conditions must be included and attached as the last page of the finalized job description.
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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