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Prior Authorization Utilization Review Jobs in Reston, VA

UHS

Utilization Review Coordinator

Washington, DC · On-site

$33.60 - $50.40/hr

Six months psychiatric utilization review either for hospital or external review organization ... authorization. Please note that we do not use this information to pre-screen job applicants. EEO ...

UHS

Utilization Review Coordinator

Washington, DC · On-site

... authorization. Please note that we do not use this information to pre-screen job applicants. EEO ... Six months psychiatric utilization review either for hospital or external review organization ...

UHS

Utilization Review Coordinator

Washington, DC · On-site

... authorization. Please note that we do not use this information to pre-screen job applicants. EEO ... Six months psychiatric utilization review either for hospital or external review organization ...

MFA

Prior-Authorization Technician- Pharmacy

Arlington, VA · On-site

$23.46 - $30.50/hr

Work with the provider to resolve prior authorization denials, peer-to-peer reviews, and denials * At all times, maintain a courteous interaction with patients, visitors, departments, and medical ...

MFA Co

Prior-Authorization Technician- Pharmacy

Arlington, VA · On-site

$20.25 - $24.50/hr

Work with the provider to resolve prior authorization denials, peer-to-peer reviews, and denials * At all times, maintain a courteous interaction with patients, visitors, departments, and medical ...

VSI

Insurance Authorization Specialist

Reston, VA · On-site

$19 - $25.25/hr

... prior authorization approvals and denials in addition to facilitating appeals and peer-to-peer reviews with the payer. * Responsible for insurance benefits verification. * Works directly with the ...

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Prior Authorization Utilization Review information

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How much do prior authorization utilization review jobs pay per hour?

As of Aug 16, 2026, the average hourly pay for prior authorization utilization review in Reston, VA is $43.99, according to ZipRecruiter salary data. Most workers in this role earn between $34.76 and $50.53 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Prior Authorization Utilization Review specialist?

To thrive as a Prior Authorization Utilization Review Specialist, you need a strong understanding of medical terminology, insurance guidelines, and clinical criteria, often supported by a degree in healthcare or nursing and relevant certification (such as RN or LPN). Familiarity with prior authorization software, electronic health record (EHR) systems, and payer portals is typically required. Attention to detail, strong communication skills, and the ability to multitask help professionals excel in this role. These competencies ensure accurate and timely processing of authorizations, reducing delays in patient care and ensuring compliance with payer requirements.

How do I get into a prior authorization utilization review?

To enter a prior authorization utilization review role, candidates typically need a background in healthcare, nursing, or health administration, along with knowledge of insurance policies and medical coding. Relevant certifications such as Certified Professional Coder (CPC) or Certified Utilization Review Professional (CURP) can enhance prospects, and experience with electronic health records (EHR) systems is often required.

What is a Prior Authorization Utilization Review specialist?

A Prior Authorization Utilization Review specialist is a healthcare professional responsible for evaluating medical service requests to ensure they meet specific criteria for approval before services are provided. Their main role is to review clinical information, verify medical necessity, and ensure compliance with insurance policies and guidelines. They act as a liaison between healthcare providers, insurance companies, and patients to facilitate timely and accurate authorization decisions. This process helps to manage healthcare costs and ensure patients receive appropriate care.

What is the difference between Prior Authorization Utilization Review vs Medical Reviewer?

AspectPrior Authorization Utilization ReviewMedical Reviewer
CredentialsLicensed healthcare professionals, often with certifications in utilization reviewLicensed physicians or healthcare providers with clinical expertise
Work EnvironmentInsurance companies, healthcare organizations, or third-party review firmsHospitals, clinics, insurance companies, or consulting firms
Primary FocusAssessing the necessity of procedures or treatments before approvalEvaluating clinical records to determine medical necessity and appropriateness

While both roles involve clinical assessment, Prior Authorization Utilization Review focuses on pre-authorization decisions for treatments, whereas Medical Review involves detailed clinical evaluation of patient records to determine medical necessity. Both require healthcare credentials and are integral to healthcare quality and cost management.

Is prior authorization utilization review a stressful job?

Prior authorization utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. The role often involves reviewing medical documentation and making quick decisions, which can lead to pressure and workload challenges, especially during high-volume periods.

What are some common challenges faced by professionals in Prior Authorization Utilization Review roles, and how can these be managed?

Professionals in Prior Authorization Utilization Review often encounter challenges such as navigating complex insurance policies, managing high volumes of requests, and ensuring timely communication between providers and payers. Staying organized, developing a thorough understanding of payer guidelines, and maintaining clear, consistent communication are key strategies for managing these challenges. Many teams also rely on workflow management tools and regular team huddles to streamline processes and ensure all cases are handled efficiently.

What are popular job titles related to Prior Authorization Utilization Review jobs in Reston, VA?

For Prior Authorization Utilization Review jobs in Reston, VA, the most frequently searched job titles are:

What job categories do people searching Prior Authorization Utilization Review jobs in Reston, VA look for?

The top searched job categories for Prior Authorization Utilization Review jobs in Reston, VA are:

What cities near Reston, VA are hiring for Prior Authorization Utilization Review jobs?

Cities near Reston, VA with the most Prior Authorization Utilization Review job openings:

Prior Authorization Utilization Review jobs near you
Infographic showing various Prior Authorization Utilization Review job openings in Reston, VA as of August 2026, with employment types broken down into 82% Full Time, and 18% Part Time. Highlights an 100% In-person job distribution, with an average salary of $91,496 per year, or $44 per hour.

Prior Authorization Pharmacist

Accede Solutions Inc.

Mclean, VA • On-site

$59.75 - $71.75/hr

Other

Re-posted 27 days ago

Job description

Prior Authorization (PA) Pharmacist

The Prior Authorization (PA) Pharmacist would facilitate efforts in the review of clinical documentation and the Preferred Drug list (PDL) to determine proper medication therapy. The PA pharmacist will work with internal and external stakeholders in evaluating and continually developing a strategy for Utilization Management.

Responsibilities:

  • Clinical evaluation of medication therapy using established clinical or PDL criteria, drug compendia, and appropriate methods that support the principles of high-quality evidence-based medicine
  • Peer to Peer discussions with medical providers to discuss Prior Authorization reviews.
  • Consultations/Interventions: work with staff in contacting prescribers needing consultation to provide clinical information on prescribing practices that have been identified as outliers. Reviews prior authorizations data and determine opportunities for interventions.
  • Intervention Refinements: Collaborates on the refinement of consultation scripting; solicits and utilizes input from those contacted toward scripting improvements.
  • Operations: Contributes to the success of the Clinical Call Centers and Prior Authorization department by assisting with the implementation and management of both written and verbal communications to members and physicians. Is available for consultation on pharmacy-related questions and issues for others within the organization.
  • Quality Improvement: Contributes to program improvements by using continuous quality improvement processes, by being proactive in identifying improvement opportunities and by contributing on-going consultation and collaboration with product leaders.
  • Medical/Clinical: Upholds clinical integrity of pharmaceutical solutions by staying up to date on medication information, contributing to the identification of pharmacy program best practices, collaborating with Medical Directors, Clinical Pharmacist, and Clinical Specialty Pharmacist to provide pharmacy expertise.
  • Drug Review: Provides clinical input during the weekly drug file updates, making recommendations on applying utilization controls
  • Other duties as assigned. Contributes creative solutions to improve operational efficiency and effectiveness of pharmacy team

Qualifications:

  • Experience in the coordination of and collaboration of work teams preferred.
  • Ability to perform clinical reviews using relevant compendia and clinical trial data.
  • Managed care pharmaceutical service experience a plus.
  • Strong research and implementation skills in practical settings.
  • Analytical skills which can translate into practical and pragmatic recommendations.
  • Strong team orientation with respect for all members.
  • People skills are essential that allow for the successful consultation and collaboration with internal and external stakeholders who do not directly report to this job.

Requirements:

  • PharmD or B.S. in Pharmacy with relevant Specialty background
  • Registered Pharmacist with respective State Licensure
  • 4 years' experience in clinical pharmacy
  • Strong verbal and written communications skills.
  • Highly skilled with Microsoft office products and ability to quickly learn proprietary systems.

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