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Case Manager Utilization Review Nurse Jobs in Reston, VA

Encompass Health

Case Manager II

Aldie, VA · On-site

Participate in utilization review process: data collection, trend review, and resolution actions ... For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN ...

Encompass Health

Case Manager II

Aldie, VA · On-site

Participate in utilization review process: data collection, trend review, and resolution actions ... For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN ...

Inova

Manager Case Management

Falls Church, VA · On-site

$21.25 - $27.50/hr

Three (3) years of experience in case management or relevant nursing experience to include utilization review, discharge planning, outcomes management, transitional planning, assessment, care ...

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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 18, 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 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.

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 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 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.

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 76% Full Time, 13% Part Time, and 11% Contract. Highlights an 85% In-person, and 15% Remote job distribution, with an average salary of $102,859 per year, or $49.5 per hour.

Case Manager Registered Nurse

Suburban Hospital

Bethesda, MD • On-site

Other

Life, Retirement

Posted 4 days ago

Job description

Make It Happen At Hopkins!

Johns Hopkins Medicine, a nonprofit, combines over 125 years of commitment to community care with groundbreaking research, teaching and medical services to patients worldwide. Johns Hopkins Medicine operates six academic and community hospitals, four health care and surgery centers, more than six ambulatory surgery centers and has more than 2.8 million outpatient encounters per year.

In collaboration with patients/families, social workers, physicians and the interdisciplinary team, the Case Manager provides leadership and advocacy in the coordination of patient-centered care across the continuum to facilitate optimal transitions and progression in care. The Case Manager manages clinical resources and transition planning for patients within an assigned caseload from pre-admission through post-discharge, actively working to identify/ eliminate barriers to the delivery of clinical services with the patient, family and care team.

Who Should Apply:

  • Bachelors Degree BSN (Required)
  • Minimum 2 years of clinical nursing experience required. One (1) year of experience in case management, discharge planning or utilization review, preferred.
  • Valid state license as a registered professional nurse (required).
  • CPR- Basic CPR (required)
  • Certification in case management by a national accreditation organization i.e. – Registered Nurse (ACM – RN) / Certified Case Manager (CCM), preferred.

We're proud to offer a robust benefits package that supports your health, growth, and well-being. Discover our full offerings and costs here: mybenefitsjhhs.com

What Awaits You:

  • Competitive pay and benefits that support you at every stage of your life and career.
  • Retirement plans with employer contributions to help you plan confidently for the future.
  • Generous time off so you can unplug, recharge, and enjoy life outside of work.
  • Access to world-class facilities and innovative technology that fuel your curiosity.
  • Endless opportunities to advance your career as part of the Johns Hopkins team.

Salary Range: Minimum 43.25/hour - Maximum 67.04/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.

The Hospital reserves the right to modify employee schedules as needed.

We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.

Johns Hopkins Health System and its affiliates are an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

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