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Insurance Utilization Review Jobs in Washington, DC

Luminis Health

Utilization Management Nurse

Annapolis, MD

$34 - $55/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Reviews the medical record by applying utilization review criteria, to assess clinical, financial ... Pay Range $34--$55 USD Luminis Health Benefits Overview: • Medical, Dental, and Vision Insurance ...

Luminis Health

Utilization Management Nurse

Lanham, MD

$34 - $55/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Reviews the medical record by applying utilization review criteria, to assess clinical, financial ... Pay Range $34--$55 USD Luminis Health Benefits Overview: • Medical, Dental, and Vision Insurance ...

Gaudenzia

Clinical Review Clinician

Washington, DC · On-site

$85K/yr

We are seeking master's level, licensed, clinician, with documented experience in utilization ... insurance requirements, and relevant treatment guidelines * Ensure accurate, up-to-date records ...

Gaudenzia

Clinical Review Clinician

Washington, DC · On-site

$85K/yr

We are seeking master's level, licensed, clinician, with documented experience in utilization ... insurance requirements, and relevant treatment guidelines * Ensure accurate, up-to-date records ...

New

Comagine Health

Clinical Reviewer DC

Washington, DC · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Medical, dental and vision insurance * Paid time off for vacation, illness and volunteering ... Document utilization review decision in the appropriate database. * Act as a resource for peers and ...

Comagine

Clinical Reviewer DC

Washington, DC · On-site

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Medical, dental and vision insurance * Paid time off for vacation, illness and volunteering ... Document utilization review decision in the appropriate database. * Act as a resource for peers and ...

Commence

Clinical Medical Director

Annapolis Junction, MD · On-site

$275K - $375K/yr

Background in health insurance, utilization review, or healthcare claims processing, including familiarity with medical necessity criteria and coverage determination standards. * Demonstrated ...

Maximus

Consultant - Medical (Case Reviewer 2)

VA · On-site +1

  • Medical

  • Life

  • Retirement

  • PTO

... Utilization review standards and practices. - State-specific workers' compensation guidelines and pricing structure. - Health Insurance Portability and Accountability Act (HIPAA) and related health ...

TEKsystems

Insurance Verification Coordinator

Annapolis, MD · Remote

$17.50 - $26/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Insurance Verification Coordinator Location: Remote (Must reside in Maryland, Pennsylvania ... utilization review, and clinical departments to secure required approvals. • Notify patients and ...

Maryland Physicians Care

Pharmacy Benefit Coordinator

Linthicum, MD · On-site +1

$67K - $72K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... utilization review, quality improvement, provider relations, and population health initiatives ... Experience working in a managed care, insurance, PBM, or equivalent environment is strongly ...

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All JobsInsurance Utilization Review JobsInsurance Utilization Review Jobs in Washington, DC

Insurance Utilization Review information

See Washington, DC salary details

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How much do insurance utilization review jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for insurance utilization review in Washington, DC is $47.87, according to ZipRecruiter salary data. Most workers in this role earn between $37.84 and $55.00 per hour, depending on experience, location, and employer.

What are the most common challenges faced by insurance utilization review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

What are the key skills and qualifications needed to thrive in insurance utilization review?

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What is an insurance utilization review?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are popular job titles related to Insurance Utilization Review jobs in Washington, DC?

For Insurance Utilization Review jobs in Washington, DC, the most frequently searched job titles are:

What job categories do people searching Insurance Utilization Review jobs in Washington, DC look for?

The top searched job categories for Insurance Utilization Review jobs in Washington, DC are:

Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Washington, DC as of August 2026, with employment types broken down into 1% As Needed, 70% Full Time, 24% Part Time, and 5% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $99,571 per year, or $47.9 per hour.

Utilization Management Nurse

Luminis Health

Annapolis, MD

$34 - $55/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 2 days ago

Luminis Health rating

7.9

Company rating: 7.9 out of 10

Based on 54 frontline employees who took The Breakroom Quiz

108th of 887 rated healthcare providers

Job description

Position Objective:  Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment.  

Essential Job Duties:

1. Chart Review:

Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource utilization; enters clinical review in EPIC; maintains close communication with external reviews, care coordinators, and providers; reconciles and records days authorized in EPIC

2. Denial Management:

Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken to avoid denial;  assists Care Coordinator in communicating with the patient denied hospital days with work toward resolution and discharge.

3. Care Coordination:

Collaborates with the Care Coordinator to achieve optimal and efficient patient outcomes while decreasing length of stay, avoidable delays and denied days; utilizes Physician Advisor and administrative personnel for unresolved issues; identifies opportunities for expedited appeals and collaborates with the care coordinator and Physician Advisor to resolve payer issues.

4.  Process improvement initiatives

Participates in nursing unit and department clinical outcome projects as well as process improvement initiatives of care management.

Educational/Experience Requirements:

  • Bachelor’s of Science in Nursing or Associate’s degree in Nursing with equivalent experience.  BSN must be achieved within 5 years of start date in the role.  
  • Three years of clinical nursing in an acute care hospital setting.

RequiredLicense/Certifications:

  • Current RN license from Maryland Board of Nursing.

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will be exposed to blood-borne pathogens.

Physical Demands -

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.

Pay Range
$34—$55 USD

Luminis Health Benefits Overview:
•    Medical, Dental, and Vision Insurance
•    Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
•    Paid Time Off
•    Tuition Assistance Benefits
•    Employee Referral Bonus Program
•    Paid Holidays, Disability, and Life/AD&D for full-time employees
•    Wellness Programs
•    Employee Assistance Programs and more
*Benefit offerings based on employment status

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