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Case Manager Utilization Review Nurse Jobs in Reston, VA

Prime Time Healthcare

Utilization Review

Washington, DC · On-site

Now Hiring: RN Utilization Review - Washington, DC Are you a passionate RN professional looking for a new adventure? Prime Time Healthcare is seeking dynamic individuals like you to join our team in ...

American Traveler

Travel Case Manager RN

Lanham, MD · On-site

Travel RN - Case Management/Utilization Review - Case Management About American Traveler With over 25 years of experience, American Traveler has established a reputation for outstanding customer ...

New

UHS

Utilization Review Coordinator

Washington, DC · On-site

$33.60 - $50.40/hr

Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...

UHS

Utilization Review Coordinator

Washington, DC

Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...

UHS

Utilization Review Coordinator

Washington, DC · On-site

Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...

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All JobsCase Utilization Review Nurse JobsCase Manager Utilization Review Nurse JobsCase Manager Utilization Review Nurse Jobs in Reston, VA

Case Manager Utilization Review Nurse information

See Reston, VA salary details

$20

$49

$83

How much do case manager utilization review nurse jobs pay per hour?

As of Aug 9, 2026, the average hourly pay for case manager utilization review nurse in Reston, VA is $49.45, according to ZipRecruiter salary data. Most workers in this role earn between $36.78 and $59.76 per hour, depending on experience, location, and employer.

What is the difference between Case Manager Utilization Review Nurse vs Case Manager?

AspectCase Manager Utilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community health, insurance providers
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

While both roles involve patient care coordination, the Case Manager Utilization Review Nurse primarily focuses on reviewing medical necessity and insurance approvals, whereas the Case Manager handles broader patient care coordination and discharge planning. Both roles require nursing credentials and are vital in healthcare settings, but their specific responsibilities differ.

How does a case manager utilization review nurse typically collaborate with physicians and other healthcare providers?

Case Manager Utilization Review Nurses regularly work with physicians, social workers, and other healthcare professionals to ensure patients receive appropriate care while managing resource utilization. They often participate in interdisciplinary team meetings to discuss care plans, review patient progress, and address any barriers to discharge. Building strong communication channels and maintaining up-to-date clinical knowledge are essential, as nurses must advocate for patients while also supporting evidence-based practices and regulatory compliance. This collaborative environment helps streamline patient care and optimize outcomes.

What is a case manager utilization review nurse?

A Case Manager Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, coordinate with healthcare providers, and ensure that treatments meet established guidelines and insurance requirements. Their goal is to optimize patient outcomes while controlling healthcare costs and ensuring compliance with regulations. These nurses also help facilitate communication between patients, providers, and payers to support effective care management.

What are the key skills and qualifications needed to thrive as a case manager utilization review nurse, and why are they important?

To excel as a Case Manager Utilization Review Nurse, you need a solid background in nursing, strong clinical assessment skills, and a valid RN license, often with case management certification. Familiarity with utilization review software, electronic health record (EHR) systems, and knowledge of insurance and regulatory guidelines is essential. Exceptional communication, critical thinking, and negotiation abilities set top performers apart in this role. These qualifications ensure effective patient advocacy, cost-effective care, and compliance with healthcare standards.

What does a case manager utilization review nurse do?

A case manager utilization review nurse evaluates medical cases to determine the necessity, appropriateness, and efficiency of healthcare services. They review patient records, collaborate with healthcare providers, and ensure treatment plans comply with insurance and regulatory guidelines, often using electronic health record systems. This role requires clinical nursing experience and knowledge of healthcare policies.
What are popular job titles related to Case Manager Utilization Review Nurse jobs in Reston, VA? For Case Manager Utilization Review Nurse jobs in Reston, VA, the most frequently searched job titles are:
What job categories do people searching Case Manager Utilization Review Nurse jobs in Reston, VA look for? The top searched job categories for Case Manager Utilization Review Nurse jobs in Reston, VA are:
What cities near Reston, VA are hiring for Case Manager Utilization Review Nurse jobs? Cities near Reston, VA with the most Case Manager Utilization Review Nurse job openings:
Case Manager Utilization Review Nurse jobs near you
Infographic showing various Case Manager Utilization Review Nurse job openings in Reston, VA as of August 2026, with employment types broken down into 82% Full Time, 17% Part Time, and 1% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $102,859 per year, or $49.5 per hour.

Travel Nurse RN - Case Manager, Utilization Review - $2,917 per week

American Traveler

Silver Spring, MD • On-site

$2.9K/wk

Other

Medical, Dental, Vision, Life, Retirement

Re-posted 9 days ago

Job description

American Traveler is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Silver Spring, Maryland.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Start Date: ASAP
  • Duration: 13 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel
Assignment Overview
  • Shift: Days, 5x8hrs
  • Hours: 40 hrs/wk
  • Start Date: May 4, 2026
  • Length: 13 weeks
  • Openings: 1
Description

American Traveler is hiring a travel RN Case Manager for a 13-week acute inpatient care coordination role requiring at least 1 year of acute care experience and knowledge of health care reimbursement systems.

Details
  • Acute inpatient hospital setting focused on care coordination and discharge planning
  • Day shift: 8:30 AM to 5:00 PM, 8-hour shifts
  • 40 hours per week
  • Uses Epic EMR
Requirements
  • Active MD or Compact RN license required — no pending licenses accepted
  • Associate's Degree in Nursing (ADN) required
  • Minimum 1 year of experience in an acute medical/surgical, ED, or critical care nursing setting
  • Experience using an electronic medical record (EMR) system
  • Knowledge of health care reimbursement systems including Medicare Advantage, commercial payers, Medicaid, and CMS regulatory rules
  • Epic EMR experience
  • Last 4 digits of SSN and date of birth required for consideration
Additional Information
  • Responsible for overseeing management and coordination of care for the acute inpatient population
  • Completes initial face-to-face assessments for every admitted patient within 24 hours of admission to identify discharge needs
  • Collaborates with hospital-based physicians, patients and families, nursing, utilization review, and other healthcare team members to support clinical and cost-effective outcomes
  • Coordinates referrals with in-network vendors for post-acute levels of care including Home Health, DME, IV Infusion, SNF Sub-Acute, and Acute Rehab
  • Facilitates transitions of care with community providers and ambulatory case managers to support safe discharge and reduce readmissions
  • Documents assessment outcomes and discharge plans in accordance with facility policies and regulatory requirements
  • Local candidates are welcome to apply
  • Travelers may not exceed two years of cumulative assignment time within the facility's system without a 90-day consecutive break

American Traveler Job ID #P-699792. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Travel RN - Case Management/Utilization Review - Case Management

About American Traveler

With over 25 years of experience, American Traveler has established a reputation for outstanding customer service. Our team ensures a smooth, worry-free experience for those starting on or expanding their travel nursing and allied careers.

With thousands of travel nursing and allied jobs nationwide, our attentive and approachable recruiters find positions that align perfectly with your career aspirations and personal requirements.

American Traveler offers exceptional benefits, including premium medical, dental, vision and life insurance beginning day one of your assignment, generous 401(k) match, substantial housing stipends, and more. Additionally, with 24/7 support and access to our in-house clinicians, you are assured confidence and comfort throughout your assignment.

With our team behind you, you can relax and enjoy a rewarding travel career.

Why Vivian Health?

Be sure to apply via Vivian Health to increase your chances of landing your perfect job. Just complete your Vivian Health profileonce, and get access to thousands of opportunities across the country. Then keep up to date with your job application process and conversations with our easy to use app.

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