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Utilization Reviewer Jobs in Virginia (NOW HIRING)

UHS

Utilization Review Coordinator

Portsmouth, VA · On-site

Prefers minimum two years of Utilization Review/Management, Quality Assurance or Risk Management. Knowledge of DMAS regulations and experience in Acentra/Kepro and Humana/Tricare portal is highly ...

UHS

Utilization Review Coordinator

Portsmouth, VA · On-site

Prefers minimum two years of Utilization Review/Management, Quality Assurance or Risk Management. Knowledge of DMAS regulations and experience in Acentra/Kepro and Humana/Tricare portal is highly ...

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 ...

Summit BHC

Utilization Assistant

Williamsburg, VA · On-site

Assists in utilization reviews and insurance appeals. Responds to inquiries from patients, their families, and professional referral sources. Roles and Responsibilities: • Assists the admissions ...

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 ...

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Showing results 1-20

All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Virginia

Utilization Reviewer information

See Virginia salary details

$30.7K

$37.7K

$43.6K

How much do utilization reviewer jobs pay per year?

As of Jun 28, 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 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.

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 does a utilization reviewer do?

A utilization reviewer evaluates medical records and treatment plans to determine the necessity and appropriateness of healthcare services. They ensure that services comply with insurance policies and industry standards, often using healthcare management software and adhering to regulatory guidelines. This role supports cost containment and quality assurance in healthcare organizations.

How to become a utilization reviewer?

To become a utilization reviewer, candidates typically need a healthcare-related degree such as nursing, health administration, or a related field. Relevant experience in healthcare or insurance, strong analytical skills, and familiarity with medical coding and documentation are important; some roles may require certification such as the Certified Professional Utilization Review (CPUR).

What jobs pay 2000 a day?

Utilization reviewers typically do not earn $2000 a day; such high daily earnings are more common in specialized roles like senior surgeons, high-level consultants, or certain executive positions. These roles often require advanced certifications, extensive experience, and work in high-paying industries such as healthcare, finance, or law. Most utilization review positions offer salaries that are significantly lower than this daily rate.

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 job makes $10,000 a month without a degree?

A utilization reviewer typically earns between $4,000 and $8,000 per month, depending on experience and location, and usually requires relevant healthcare or insurance knowledge. Jobs that can pay $10,000 a month without a degree include high-level sales, real estate brokers, or certain skilled trades like commercial pilots or specialized technicians, often requiring certifications or extensive experience. These roles often involve self-employment, commissions, or high-demand skills that compensate well without formal college degrees.

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.
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 June 2026, with employment types broken down into 52% Full Time, 31% Part Time, and 17% Contract. Highlights an 59% Physical, 2% Hybrid, and 39% Remote job distribution, with an average salary of $37,666 per year, or $18.1 per hour.
Clinical Coordinator - Utilization Review

Clinical Coordinator - Utilization Review

Hampton-Newport News Community Services Board

Hampton, VA • On-site

$62K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 15 days ago

Key responsibilities

  • Conduct clinical reviews of acute and intermediate care admissions to assess clinical necessity and appropriateness of care.

  • Manage utilization of beds daily to ensure timely and clinically appropriate movement of individuals.

  • Communicate findings and recommendations regarding treatment and placement between hospitals, facilities, and CSB staff.

Job description

Clinical Coordinator - Utilization Review

Annual Salary: $62,406

Work Schedule: Monday - Friday 8:30 am - 5:00 pm

The Hampton - Newport News Community Services Board (CSB) is hiring a Clinical Coordinator - Utilization Review for the Region 5 Reinvestment Initiative. This full-time Clinical Coordinator - Utilization Review is responsible for conducting clinical reviews of acute and intermediate care for clinical necessity and appropriateness of care and for managing utilization of beds on a daily basis to ensure movement in a clinically appropriate and expeditious manner. Major duties will include conducting clinical reviews, acute care bed management, and communication of findings and recommendations between hospitals, facilities, and CSB staff. This position will report to the Project Director of the Region 5 Reinvestment Initiative.

ROLE SUMMARY

The Clinical Coordinator (Utilization Review) ensures individuals receive the most appropriate and effective behavioral health services by conducting clinical reviews of acute care and crisis stabilization admissions. Evaluates medical necessity, monitors continued stay criteria, and makes recommendations regarding the most appropriate level of care. Working closely with hospitals, Community Services Board (CSB) staff, and regional partners, coordinates communication, tracks consumer placements, and provides clinical guidance to support informed treatment and placement decisions. Responsibilities include conducting face-to-face assessments, monitoring treatment progress and outcomes, promoting quality and cost-effective care, and preparing regular utilization reports with recommendations for acute, sub-acute, or community-based services. This position plays a critical role in ensuring consumers receive timely, clinically appropriate, and least restrictive treatment options while supporting regional behavioral health initiatives.

To qualify for this position, candidates must have:

  • Master's degree in Human Services.
  • Three (3) years of experience in behavioral health, including utilization management.

BENEFITS

  • Health, Vision, and Dental Insurance
  • Virginia Retirement System
  • Flexible Spending Account (FSA)
  • Life Insurance
  • 11 Paid Holidays

The selected candidate must successfully pass a criminal history fingerprint background investigation, DMV record check, Child Registry search, drug screening test and employment reference checks.

Apply