Registered Nurse (RN) - Utilization Management (Remote)

About the Role

This position places you at the intersection of clinical care, compliance, and operational excellence. You will independently assess medical necessity, collaborate across care teams, and ensure alignment with regulatory and payer standards in a fast-moving hospital environment.

On a Typical Day, You Will

• Review patient admissions to determine medical necessity and appropriate level of care
• Evaluate whether patients are placed in the correct admission status and timeframe
• Ensure adherence to CMS, Medicare, and payer-specific guidelines
• Communicate with physicians, nurses, and care teams to clarify or adjust patient status as needed
• Engage with insurance payers to support authorization and reimbursement processes
• Identify and act on opportunities to maintain compliance and optimize outcomes

Additional Highlights

• Highly autonomous role requiring independent decision-making
• Frequent collaboration with interdisciplinary teams
• Exposure to a broad and diverse patient population
• Monday through Friday schedule (8:00 AM – 4:30 PM)
• No on-call requirements and no weekend rotations
• Limited, shared holiday coverage

Why UVA Health

UVA Health is a nationally recognized academic health system where clinical expertise, innovation, and collaboration come together to deliver outstanding patient care. In Utilization Management, your role is essential to maintaining both the quality and sustainability of care delivery. This position is ideal for nurses looking to transition from bedside care into a strategic, systems-level role while still leveraging their clinical foundation.

You Will Be Part Of An Environment That Offers:

• A leading academic medical center known for advancing evidence-based care and clinical excellence
• A role that directly supports regulatory compliance, reimbursement integrity, and patient-centered outcomes
• A team culture that values autonomy, accountability, and continuous learning
• Opportunities to deepen expertise in utilization management, payer strategy, and case management pathways
• Collaboration with highly skilled clinicians across a complex, multidisciplinary health system

Why People Love Living in Charlottesville

Charlottesville offers an exceptional quality of life, combining the energy of a vibrant university town with the natural beauty of the Blue Ridge Mountains. Healthcare professionals are drawn to the area for the balance of career opportunity and lifestyle, with access to outdoor recreation, a thriving food and arts scene, and a strong sense of community. Whether enjoying local vineyards, hiking scenic trails, or experiencing cultural events, Charlottesville provides an environment that supports both personal well-being and professional fulfillment.

Minimum Requirements

• Education: Bachelor of Science in Nursing from accredited nursing program.
• Experience: 2 years acute care hospital experience.
• Licensure: Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia required.

Physical Demands

Job requires sitting for prolonged periods. Proficient communicative, auditory and visual skills; Attention to detail and ability to write legibly.

Pay

The pay range for this role is $76,398.40 - $122,241.60 annually. Individual compensation will be determined by the selected candidate's qualifications, previous work experience, and/or education.

Benefits

• Medical, Dental, and Vision Insurance
• Paid Time Off, Long-term and Short-term Disability, Retirement Savings
• Health Saving Plans, and Flexible Spending Accounts
• Certification and education support
• Generous Paid Time Off