Sam SmithRoanoke, Virginia, may be known for its mountain views and vibrant outdoor lifestyle, but it also offers a growing professional landscape with strong earning potential across several key industries. Anchored by world-class healthcare institutions like Carilion Clinic and LewisGale Medical Center, the region supports high-paying medical, executive, technology, legal, and engineering roles. With a lower-than-average cost of living and expanding biotech and research activity through the Virginia Tech–Carilion partnership, Roanoke provides competitive income opportunities and exceptional quality of life for skilled professionals.
Highest-paying Jobs in Roanoke, VA – Value In Numbers:
1. Physician / Surgeon
Physicians and surgeons are the highest-earning professionals in Roanoke, particularly specialists like orthopedic surgeons, anesthesiologists, cardiologists, and radiologists. With Carilion Clinic and LewisGale Medical Center driving regional demand, these roles command strong salaries due to years of training, residency, and advanced certifications. Physicians diagnose and treat complex medical conditions, perform surgeries, and manage patient care plans. They also play a central role in Roanoke’s expanding healthcare research and innovation ecosystem connected to Virginia Tech Carilion School of Medicine.
2. Chief Executive Officer (CEO)
CEOs in Roanoke lead major healthcare systems, banks, manufacturing firms, and corporate offices like Advance Auto Parts. They oversee organizational strategy, financial performance, leadership teams, and long-term growth initiatives. With compensation tied to results and industry influence, CEOs typically have decades of executive experience and often hold MBAs. In Roanoke’s evolving economy, CEOs guide expansion projects in healthcare, education, and regional technology sectors, while managing workforce development and maintaining strong community and stakeholder partnerships.
3. Psychiatrist
Psychiatrists diagnose and treat mental health disorders, including anxiety, depression, trauma-related conditions, and severe psychiatric illnesses. With rising demand for behavioral health services across Virginia, especially in hospital systems and private clinics, psychiatrists in Roanoke earn competitive salaries. They prescribe medication, conduct evaluations, and offer therapeutic guidance. Many work within Carilion Clinic’s behavioral health programs, addressing growing mental health needs across the region. Specialized training, board certification, and medical licensing are required, making this a high-skill, high-demand role.
4. Chief Financial Officer (CFO)
CFOs oversee financial planning, investment strategy, budgeting, and risk management for major Roanoke organizations, particularly in healthcare, banking, and corporate services. They ensure fiscal stability, support growth decisions, and manage accounting and finance teams. Most have extensive financial backgrounds, MBAs or CPAs, and decades of leadership experience. In Roanoke, CFOs often coordinate funding for major hospital expansions, municipal projects, and corporate development initiatives, balancing economic growth with long-term financial sustainability and regulatory compliance.
5. Nurse Anesthetist (CRNA)
CRNAs are advanced practice nurses who administer anesthesia and manage patient anesthesia care before, during, and after surgical procedures. With Roanoke’s expanding regional hospital network and surgical centers, CRNAs play a vital role and command high earnings. They collaborate closely with physicians and surgeons and must hold advanced degrees, certification, and clinical experience. This role demands strong medical judgment, precision, and patient-care expertise, making it one of the most sought-after and competitive nursing careers in the region.
6. Vice President (Corporate / Medical)
Vice Presidents in Roanoke support strategic leadership across hospitals, universities, banks, and large corporations. They oversee departments such as operations, finance, medical affairs, and engineering. These leaders translate company goals into measurable performance results, manage budgets, and lead multi-disciplinary teams. Most VPs have 10+ years of senior management experience and often advanced degrees. In Roanoke’s healthcare-driven economy, medical-system VPs are particularly in demand to support expansion, research growth, and innovation initiatives.
7. Hospital Administrator
Hospital Administrators guide the strategic, operational, and financial management of healthcare facilities across Roanoke. They coordinate patient services, staffing, regulatory compliance, and quality-of-care programs, often overseeing large teams and multi-department structures. With Carilion’s regional expansion and the Virginia Tech health innovation ecosystem, demand is strong. Administrators typically hold a Master’s in Healthcare Administration or MBA and must balance medical priorities with financial performance, ensuring hospitals deliver high-quality care and sustainable clinical growth.
8. Anesthesiologist
Anesthesiologists specialize in pain management and surgical anesthesia, making them essential for hospital operations in Roanoke’s surgical and trauma units. They administer anesthesia, monitor patient vital functions, and provide pain-control plans. These physicians require extensive training, residency, and board certification. Roanoke’s health systems offer strong demand in operating rooms, outpatient surgery centers, and emergency care environments. Their expertise ensures safe, successful surgeries and contributes significantly to patient outcomes across a growing healthcare landscape.
9. Radiologist
Radiologists interpret medical imaging, including MRIs, CT scans, ultrasounds, and X-rays, to diagnose illnesses and guide surgical decisions. With Roanoke’s advanced medical facilities and growing diagnostic centers, radiologists are highly compensated specialists. They collaborate with physicians across multiple departments, such as oncology, orthopedics, and emergency medicine. Extensive training, residency, and imaging specialization are required. Radiologists play a vital role in early disease detection and ongoing treatment planning, supporting Roanoke’s strong medical ecosystem.
10. Orthopedic Surgeon
Orthopedic surgeons diagnose and treat bone, joint, muscle, and spine conditions, performing surgeries for sports injuries, trauma, and degenerative diseases. With aging populations and increasing demand for mobility-related care, Roanoke’s hospital systems rely heavily on orthopedic specialists. Extensive medical education, residency training, and orthopedic specialization are required. These surgeons work in both inpatient and outpatient settings, supporting trauma services and elective surgeries, and are among the highest-earning clinical professionals in the region.
11. Cardiologist
Cardiologists diagnose and treat heart and vascular diseases, performing evaluations, catheterizations, and ongoing cardiac care. Roanoke’s hospitals feature strong cardiology programs, making this role in consistent demand. With heart disease remaining a leading medical challenge, cardiologists specialize in life-saving care, from routine monitoring to emergency intervention. Years of advanced medical training, residency, and fellowship are required. Their work significantly impacts patient longevity and community health, contributing meaningfully to Roanoke’s healthcare excellence.
12. Pharmacist
Pharmacists dispense medications, counsel patients on safe drug use, and collaborate with physicians to ensure optimal treatments. In Roanoke, they work across hospitals, retail pharmacies, long-term care facilities, and clinical support teams. A Doctor of Pharmacy degree and state licensure are required. Pharmacists also assist with medication management programs and transplant, oncology, and chronic-care services. With a growing older population in Southwest Virginia, medication therapy support drives strong local demand for skilled pharmacists.
13. General Counsel / Senior Attorney
General Counsel and senior attorneys manage legal compliance, risk mitigation, contract negotiation, and corporate governance for major Roanoke employers, including healthcare systems and financial institutions. They may also oversee litigation, intellectual-property issues, and regulatory matters. These legal professionals typically hold a Juris Doctor degree and extensive legal experience. In Roanoke, strong opportunities exist in hospital systems, banking, manufacturing, and government agencies, where legal leadership supports ethical growth and institutional protection.
14. Dentist
Dentists in Roanoke diagnose and treat oral health conditions, perform restorative procedures, manage preventative care, and operate dental practices. Many build long-term patient relationships and may specialize in orthodontics, endodontics, or oral surgery. A Doctor of Dental Surgery or Doctor of Dental Medicine degree and Virginia licensure are required. With steady community demand and potential for private practice ownership, dentistry offers high earning potential and career independence in the Roanoke region.
15. Nurse Practitioner (NP)
Nurse Practitioners provide advanced patient care, diagnose illnesses, order tests, and prescribe medications. In Roanoke, NPs serve in primary care, specialty clinics, emergency care, and hospital units. With physician shortages in some areas, NPs play a critical role in expanding access to healthcare services. They must hold a graduate nursing degree and national certification. Demand is strong across both urban and rural clinics, giving this role excellent salary and job stability.
16. Physician Assistant (PA)
PAs diagnose illnesses, develop treatment plans, assist in surgeries, and prescribe medications under physician supervision. Roanoke’s medical systems rely heavily on PAs to support expanded patient care. A Master’s PA degree, board exam, and state license are required. PAs often work in surgical specialties, emergency departments, and primary-care settings. With a growing population and expanding healthcare facilities, PAs enjoy high demand and strong compensation across the Roanoke Valley and surrounding regions.
17. Director of Finance / Controller
Finance Directors and Controllers manage corporate finances, budgeting, reporting, and regulatory compliance. In Roanoke, they work in healthcare systems, banks, manufacturing firms, and universities. These professionals typically hold CPA credentials or MBAs and manage accounting teams while advising executives on financial decisions and long-term planning. Their leadership helps organizations maintain fiscal stability and strategic growth, making this role highly compensated and essential in Roanoke’s business and healthcare sectors.
18. Senior Software Engineer
Senior Software Engineers design systems, develop scalable applications, and oversee technical architecture for organizations in healthcare, manufacturing tech, and financial services. While Roanoke’s tech sector is growing, these roles remain high-value due to specialized coding expertise and system-design capability. A bachelor’s degree in computer science or related field, combined with years of hands-on experience, is typical. Remote and hybrid tech roles have increased earning opportunities for Roanoke-based software professionals.
19. Electrical Engineer (Senior / Principal)
Senior Electrical Engineers design electrical systems, embedded electronics, automation-control equipment, and power systems for industries such as manufacturing, defense, and energy. Roanoke’s industrial employers, including TMEIC and tech-focused firms, rely on advanced engineering talent. These engineers typically hold bachelor’s or master’s degrees and Professional Engineer licensure is often preferred. Their work supports automation, manufacturing upgrades, and energy reliability, making them valuable contributors to regional innovation and industrial infrastructure.
20. Mechanical Engineer (Senior / Principal)
Senior Mechanical Engineers lead product development, mechanical design, thermal analysis, and manufacturing optimization projects. Roanoke’s industrial and technology sectors rely on experienced engineers to create automation equipment, medical devices, and industrial systems. These professionals typically hold engineering degrees and strong CAD and prototyping experience. Their work supports advanced manufacturing and engineering innovation across the region, driving productivity and competitiveness in Roanoke’s growing engineering economy.
Top 100 Highest-Paying Jobs in Roanoke, VA
| Rank | Job Title | Typical Salary Range |
|---|---|---|
| 1 | Surgeon | $350,000 – $550,000+ |
| 2 | Anesthesiologist | $350,000 – $520,000 |
| 3 | Orthopedic Surgeon | $340,000 – $500,000 |
| 4 | Cardiologist | $330,000 – $480,000 |
| 5 | Neurosurgeon | $350,000 – $600,000+ |
| 6 | Chief Executive Officer (CEO) | $250,000 – $450,000+ |
| 7 | Chief Medical Officer | $280,000 – $420,000 |
| 8 | Chief Financial Officer (CFO) | $220,000 – $380,000 |
| 9 | Psychiatrist | $230,000 – $330,000 |
| 10 | Hospital Administrator | $200,000 – $350,000 |
| 11 | VP of Operations | $180,000 – $300,000 |
| 12 | Chief Nursing Officer | $180,000 – $300,000 |
| 13 | Radiologist | $300,000 – $450,000 |
| 14 | Gastroenterologist | $330,000 – $470,000 |
| 15 | CRNA (Nurse Anesthetist) | $180,000 – $230,000 |
| 16 | General Surgeon | $280,000 – $420,000 |
| 17 | Emergency Medicine Physician | $260,000 – $380,000 |
| 18 | Oncologist | $300,000 – $450,000 |
| 19 | Ophthalmologist | $260,000 – $380,000 |
| 20 | Lawyer / Partner | $150,000 – $300,000+ |
| 21 | General Counsel | $180,000 – $330,000 |
| 22 | Dentist | $160,000 – $275,000 |
| 23 | Oral Surgeon | $200,000 – $400,000 |
| 24 | Family Medicine Physician | $200,000 – $270,000 |
| 25 | Pain Management Physician | $280,000 – $420,000 |
| 26 | Pulmonologist | $260,000 – $410,000 |
| 27 | Urologist | $300,000 – $450,000 |
| 28 | Pediatrician (Specialist) | $180,000 – $270,000 |
| 29 | Corporate VP | $170,000 – $280,000 |
| 30 | VP of HR | $160,000 – $250,000 |
| 31 | Director of Medical Services | $150,000 – $230,000 |
| 32 | VP of Marketing | $160,000 – $240,000 |
| 33 | Pharmacist | $120,000 – $150,000 |
| 34 | Data Scientist | $105,000 – $140,000 |
| 35 | Senior Software Engineer | $105,000 – $150,000 |
| 36 | Physician Assistant | $105,000 – $140,000 |
| 37 | Nurse Practitioner | $105,000 – $135,000 |
| 38 | Director of Finance | $120,000 – $170,000 |
| 39 | Senior Electrical Engineer | $100,000 – $140,000 |
| 40 | Senior Mechanical Engineer | $95,000 – $135,000 |
| 41 | Air Traffic Controller | $120,000 – $170,000 |
| 42 | IT Director | $120,000 – $180,000 |
| 43 | Senior Civil Engineer | $100,000 – $150,000 |
| 44 | Financial Controller | $110,000 – $160,000 |
| 45 | Enterprise Sales Director | $120,000 – $200,000 |
| 46 | University Professor (Senior / Med School) | $100,000 – $180,000 |
| 47 | Commercial Airline Pilot | $100,000 – $250,000 |
| 48 | HR Director | $100,000 – $150,000 |
| 49 | Marketing Director | $100,000 – $150,000 |
| 50 | Project Management Director | $110,000 – $155,000 |
| 51 | Construction Project Executive | $120,000 – $200,000 |
| 52 | IT Manager | $90,000 – $135,000 |
| 53 | Mechanical Engineering Manager | $100,000 – $150,000 |
| 54 | Director of Supply Chain | $110,000 – $170,000 |
| 55 | Nuclear Medicine Technologist (Sr) | $90,000 – $125,000 |
| 56 | Senior Accountant / CPA | $85,000 – $120,000 |
| 57 | Physician Recruiter | $90,000 – $130,000 |
| 58 | Senior Network Engineer | $90,000 – $135,000 |
| 59 | Corporate Banker | $90,000 – $150,000 |
| 60 | Wealth Management Advisor | $90,000 – $180,000+ |
| 61 | Real Estate Broker (Top Producer) | $90,000 – $300,000+ |
| 62 | Advertising Director | $85,000 – $130,000 |
| 63 | Construction Manager | $85,000 – $140,000 |
| 64 | Biomedical Engineer (Senior) | $85,000 – $130,000 |
| 65 | Veterinarian | $90,000 – $150,000 |
| 66 | Occupational Therapist (Lead) | $85,000 – $120,000 |
| 67 | Physical Therapist (Lead) | $85,000 – $120,000 |
| 68 | Physician Practice Manager | $85,000 – $130,000 |
| 69 | Speech Language Pathologist (Director) | $80,000 – $120,000 |
| 70 | Senior Loan Officer | $85,000 – $160,000 |
| 71 | Power Systems Engineer | $90,000 – $140,000 |
| 72 | Tax Manager | $95,000 – $140,000 |
| 73 | Medical Laboratory Director | $90,000 – $140,000 |
| 74 | Aviation Maintenance Manager | $85,000 – $130,000 |
| 75 | Logistics Manager | $80,000 – $120,000 |
| 76 | Senior Quality Engineer | $85,000 – $125,000 |
| 77 | Manufacturing Manager | $85,000 – $130,000 |
| 78 | Insurance Underwriting Manager | $85,000 – $135,000 |
| 79 | Pharmaceutical Sales Manager | $100,000 – $160,000 |
| 80 | Senior Database Administrator | $90,000 – $140,000 |
| 81 | Procurement Manager | $85,000 – $130,000 |
| 82 | Nurse Manager | $85,000 – $125,000 |
| 83 | Dental Hygienist (Top Earners) | $80,000 – $110,000 |
| 84 | Software Developer | $80,000 – $120,000 |
| 85 | Financial Analyst (Senior) | $80,000 – $120,000 |
| 86 | Electrical Technician (Senior) | $75,000 – $110,000 |
| 87 | Cybersecurity Specialist | $85,000 – $140,000 |
| 88 | Aviation Flight Instructor (Senior) | $80,000 – $125,000 |
| 89 | Technical Project Manager | $85,000 – $130,000 |
| 90 | Industrial Designer | $80,000 – $115,000 |
| 91 | UX/UI Designer (Senior) | $85,000 – $125,000 |
| 92 | Real Estate Appraiser (Commercial) | $75,000 – $150,000 |
| 93 | Paralegal (Senior / Law Firm) | $65,000 – $90,000 |
| 94 | Financial Auditor (Senior) | $75,000 – $115,000 |
| 95 | HR Manager | $75,000 – $120,000 |
| 96 | Medical Device Sales Rep | $90,000 – $160,000 |
| 97 | Engineer-in-Training (EIT) | $70,000 – $90,000 |
| 98 | Registered Nurse (RN) | $70,000 – $105,000 |
| 99 | Respiratory Therapist (Lead) | $70,000 – $95,000 |
| 100 | Radiation Therapist | $70,000 – $100,000 |
Closing
Roanoke’s economy continues to evolve, offering excellent earning potential for healthcare specialists, corporate leaders, engineers, and technology professionals. While salaries here may be slightly lower than in major metropolitan hubs, residents benefit from a significantly lower cost of living, shorter commutes, and a scenic, family-friendly community. Whether you’re a medical professional exploring new roles, an engineer seeking career stability, or an executive searching for leadership opportunities, Roanoke stands out as a promising place to build a rewarding and balanced professional life.