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Remote Insurance Utilization Review Jobs in Ashburn, VA

Acentra Health

Clinical, Supervisor

Mclean, VA · Remote

This position is remote U.S.*** ***Working hours between 8:00 a.m. and 6:00 p.m. EST, with ... Conduct utilization reviews as needed to support workload demands and program requirements.

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Acentra Health

Board Certified Behavior Analyst

Mclean, VA · Remote

$75.90K - $92.80K/yr

... Utilization Review or Prior Authorization. * Strong clinical assessment and critical thinking skills. * Proficiency in medical necessity review. * Ability to work independently in a remote ...

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Remote Insurance Utilization Review information

See Ashburn, VA salary details

$21

$43

$70

How much do remote insurance utilization review jobs pay per hour?

As of May 28, 2026, the average hourly pay for remote insurance utilization review in Ashburn, VA is $43.24, according to ZipRecruiter salary data. Most workers in this role earn between $34.18 and $49.66 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Remote Insurance Utilization Review Specialist, and why are they important?

To thrive as a Remote Insurance Utilization Review Specialist, you need a strong understanding of medical terminology, clinical guidelines, and insurance policies—usually supported by a nursing or health-related degree and relevant licensure. Familiarity with electronic medical record (EMR) systems, insurance claims platforms, and utilization review software is essential. Strong analytical skills, attention to detail, and effective written communication are crucial soft skills for this role. These competencies ensure accurate case evaluations, compliance with regulations, and clear communication between healthcare providers and insurers.

How does a remote insurance utilization review professional collaborate with healthcare providers and insurance companies?

Remote insurance utilization review professionals regularly interact with healthcare providers to gather patient information, clarify treatment plans, and ensure that clinical documentation supports insurance requirements. They also communicate with insurance companies to advocate for patient care, provide necessary justifications, and resolve coverage issues. While the work is done remotely, collaboration typically occurs via secure email, phone calls, and virtual meetings, requiring strong communication and organizational skills to ensure timely and accurate exchange of information.

What are remote insurance utilization review jobs?

Remote insurance utilization review jobs involve evaluating medical records and treatment plans to determine whether healthcare services are medically necessary and covered by a patient’s insurance plan. Professionals in these roles, often nurses or other healthcare specialists, work from home and communicate with healthcare providers, insurance companies, and patients. Their main goal is to ensure that patients receive appropriate care while also helping insurance companies manage costs and comply with regulations.

What is the difference between Remote Insurance Utilization Review vs Remote Claims Reviewer?

AspectRemote Insurance Utilization ReviewRemote Claims Reviewer
CredentialsTypically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professionalUsually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H
Work EnvironmentRemote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of servicesRemote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance
Industry UsageCommonly used in healthcare insurance to evaluate medical necessityUsed across insurance sectors to process and validate claims

Remote Insurance Utilization Review focuses on assessing the medical necessity of services, often requiring healthcare credentials. Remote Claims Reviewers handle claims processing and validation, emphasizing insurance knowledge. Both roles are remote and industry-specific but differ in their primary responsibilities and required qualifications.

What are popular job titles related to Remote Insurance Utilization Review jobs in Ashburn, VA? For Remote Insurance Utilization Review jobs in Ashburn, VA, the most frequently searched job titles are:
What job categories do people searching Remote Insurance Utilization Review jobs in Ashburn, VA look for? The top searched job categories for Remote Insurance Utilization Review jobs in Ashburn, VA are:
What cities near Ashburn, VA are hiring for Remote Insurance Utilization Review jobs? Cities near Ashburn, VA with the most Remote Insurance Utilization Review job openings:
Remote Insurance Utilization Review jobs near you
Infographic showing various Remote Insurance Utilization Review job openings in Ashburn, VA as of May 2026, with employment types broken down into 50% Full Time, and 50% Contract. Highlights an 50% In-person, and 50% Remote job distribution, with an average salary of $89,934 per year, or $43.2 per hour.
Remote Physician Reviewer Utilization & Claims Review

Remote Physician Reviewer Utilization & Claims Review

Dane Street

Washington, DC • Remote

Contractor

This job post has expired today. Applications are no longer accepted.

Job description

A recognized healthcare provider is seeking a Board Certified Orthopaedic Spine Surgeon to conduct utilization reviews. This telework position allows for a flexible schedule within a standard Monday – Friday work week. Responsibilities include reviewing medical records, ensuring compliance with state regulations, and providing clear rationale for case decisions.

Preferred candidates should have a license in specific states. Compensation is based on a per-case basis as a 1099 independent contractor. #J-18808-Ljbffr

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