Registered Nurse (RN) - Utilization Management (Remote)

Make a meaningful impact beyond the bedside by ensuring patients receive the right care at the right time, while supporting clinical integrity and regulatory excellence. In this role, your expertise directly influences patient outcomes, care quality, and system-wide efficiency.

As a Utilization Management RN at UVA Health, you will leverage your acute care experience to navigate complex clinical scenarios, guide admission decisions, and partner with interdisciplinary teams. This is an opportunity to expand your practice into a highly autonomous, intellectually engaging specialty that blends clinical judgment with compliance and payer strategy.

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

The work is dynamic and requires strong clinical reasoning, organization, and adaptability. While each day varies, the consistent focus is on delivering accurate, timely decisions that support both patients and the health system.

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

Relocation assistance may be available for qualified candidates.

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.

Benefits

• Comprehensive Benefits Package: 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

UVA Health is a world-class Magnet Recognized academic medical center and health system with a level 1 trauma center. 2023-2024 U.S. News & World Report “Best Hospitals” guide rates UVA Health University Medical Center as “High Performing” in 5 adult specialties and 14 conditions/procedures. We are one of 70 National Cancer Institute designated cancer centers. UVA Health Children’s is named by 2023-2024 U.S. News & World Report as the best children's hospital in Virginia with 9 specialties ranked among the best in the nation. Our footprint also encompasses 3 community hospitals and an integrated network of primary and specialty care clinics throughout Charlottesville, Culpeper, Northern Virginia, and beyond.

The University of Virginia is an equal opportunity employer. All interested persons are encouraged to apply, including veterans and individuals with disabilities. Learn more about UVA’s commitment to non-discrimination and equal opportunity employment.