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Remote Insurance Utilization Review Jobs in Springfield, VA

Karius

Clinical Sales Manager (Capitol)

Washington, DC · Remote

... and utilization review. • Secure contracts and agreements, where necessary or optimal, to ... remote and in-person, and manage follow-up. • Collaborate with Customer Success to onboard new ...

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BetterHelp

Psychiatrist - (Remote)

Washington, DC · Remote

$165 - $225/hr

At the same time, only 30% of therapists accept insurance. UpLift acts as the bridge between ... utilization of add-on codes (such as 90833) when clinically appropriate and properly documented

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BetterHelp

Psychiatrist - Remote

Washington, DC · Remote

$119 - $242/hr

At the same time, only 30% of therapists accept insurance. UpLift acts as the bridge between ... utilization of add-on codes (such as 90833) when clinically appropriate and properly documented

Apply Early

AO Globe Life

Remote- Entry Level Manager

Arlington, VA · On-site +1

Oversee customer accounts, verify coverage eligibility, and review healthcare options. * Process ... Comprehensive health insurance * Professional development opportunities * Performance-based bonuses ...

AO Globe Life

Remote- Entry Level Manager

Arlington, VA · On-site +1

Oversee customer accounts, verify coverage eligibility, and review healthcare options. * Process ... Comprehensive health insurance * Professional development opportunities * Performance-based bonuses ...

AO Globe Life

Remote- Entry Level Manager

Arlington, VA · On-site +1

Oversee customer accounts, verify coverage eligibility, and review healthcare options. * Process ... Comprehensive health insurance * Professional development opportunities * Performance-based bonuses ...

Guidehouse

Loan Review Senior Consultant

Washington, DC · On-site +1

$98K - $163K/yr

Reviewers may support onsite or remote reviews, participate in quality assurance activities, and ... Medical, Rx, Dental & Vision Insurance * Personal and Family Sick Time & Company Paid Holidays

Guidehouse

Loan Review Managing Consultant

Washington, DC · On-site +1

$113K - $188K/yr

Reviewers may support onsite or remote reviews, participate in quality assurance activities, and ... Medical, Rx, Dental & Vision Insurance * Personal and Family Sick Time & Company Paid Holidays

Guidehouse

Loan Review Senior Consultant

Mclean, VA · On-site +1

$98K - $163K/yr

Reviewers may support onsite or remote reviews, participate in quality assurance activities, and ... Medical, Rx, Dental & Vision Insurance * Personal and Family Sick Time & Company Paid Holidays

Guidehouse

Loan Review Managing Consultant

Mclean, VA · On-site +1

$113K - $188K/yr

Reviewers may support onsite or remote reviews, participate in quality assurance activities, and ... Medical, Rx, Dental & Vision Insurance * Personal and Family Sick Time & Company Paid Holidays

Guidehouse

Loan Review Managing Consultant

Mclean, VA · On-site +1

$113K - $188K/yr

Reviewers may support onsite or remote reviews, participate in quality assurance activities, and ... Medical, Rx, Dental & Vision Insurance * Personal and Family Sick Time & Company Paid Holidays

Guidehouse

Loan Review Senior Consultant

Mclean, VA · On-site +1

$98K - $163K/yr

Reviewers may support onsite or remote reviews, participate in quality assurance activities, and ... Medical, Rx, Dental & Vision Insurance * Personal and Family Sick Time & Company Paid Holidays

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All JobsRemote Insurance Utilization Review JobsRemote Insurance Utilization Review Jobs in Springfield, VA

Remote Insurance Utilization Review information

See Springfield, VA salary details

$22

$44

$72

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

As of Jun 30, 2026, the average hourly pay for remote insurance utilization review in Springfield, VA is $44.16, according to ZipRecruiter salary data. Most workers in this role earn between $34.90 and $50.72 per hour, depending on experience, location, and employer.

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.

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 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.
What job categories do people searching Remote Insurance Utilization Review jobs in Springfield, VA look for? The top searched job categories for Remote Insurance Utilization Review jobs in Springfield, VA are:
What cities near Springfield, VA are hiring for Remote Insurance Utilization Review jobs? Cities near Springfield, 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 Springfield, VA as of June 2026, with employment types broken down into 67% Full Time, 24% Part Time, 3% Temporary, 3% Contract, and 3% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $91,862 per year, or $44.2 per hour.
Clinical Sales Manager (Capitol)

Clinical Sales Manager (Capitol)

Karius

Washington, DC • Remote

Full-time

Posted 25 days ago

Be an early applicant

Job description

About Karius
Karius is a venture-backed life science startup focused on transforming the way infectious diseases are diagnosed.  Combining Next-Generation Sequencing and proprietary data analysis, we can identify over 1,000 pathogens from a single blood sample with typical turnaround time in one business day. By unlocking the information present in microbial cell-free DNA, we're helping doctors quickly solve their most challenging cases, with a future vision of accelerating clinical trials, discovering new microbes, and reducing patient suffering worldwide.
 
Position Summary
This represents an incredible opportunity to join a growing life sciences company poised to revolutionize the Infectious Disease diagnostics market. We are expanding the launch of our proprietary, Next-Generation Sequencing test in hospitals and health systems across the U.S. Joining Karius in our commercialization effort will both accelerate your career and advance our vision to see a world where infectious disease is no longer a major threat to human health.  The Clinical Sales Manager is responsible for the sales efforts of Karius in a defined regional territory, focusing on relationships with infectious disease physicians, lab directors, C-level executives, and other clinical leaders throughout a hospital system.
 
Why Should You Join Us?
Karius aims to conquer infectious diseases through innovations around genomic sequencing and machine learning. The company’s platform is already delivering unprecedented insights into the microbial landscape, providing clinicians with a comprehensive test capable of identifying more than a thousand pathogens directly from blood, and helping industry accelerate the development of therapeutic solutions. The Karius test we provide today is one of the most advanced solutions available to physicians who aim to deliver better care to many otherwise ineffectively treated patients. Our test is the result of some incredible work done by our scientists, statisticians, engineers, and physicians, all driven by the same mission. You, as part of the Karius team, will be able to see how directly your work has a life-changing impact on people, and at scale.
 
Reports to: Regional Sales Director 
 
Territory: Washington DC, Maryland, and Virginia with deep knowledge and experience in the greater metropolitan area health systems.
 
Primary Responsibilities
•   Grow sales revenue and test volume in territory by establishing new business in hospitals while increasing volume in existing hospitals. Introduce a transformational, life-saving diagnostic technology which will change the world of infectious disease by engaging key stakeholders in the hospital that are involved with the decision process to implement new diagnostic tests.
•   Collaboration with Inside Sales, Customer Success, Medical Affairs, and Marketing to achieve territory and company goals.
•   Develop thought leaders and early adopters for this new approach to infectious disease diagnosis.
•   Help establish the foundation and culture of a world-class commercial organization.
•   Build, manage and nurture market-based/regional territory, comprising hospital & health system accounts.
•   Prioritize and segment hospital & health system accounts to maximize opportunity and growth.
•   Present product features and benefits to key stakeholders and clinical call points, utilizing consultative sales techniques (qualifying leads, assessing needs, supporting evaluations, and closing). Manage early evaluations to activate initial adoption of Karius test/solutions and drive increased utilization over time.
•   Serve as a subject matter expert, speaking with clinicians of all levels regarding the science and technology of the Karius test and how to best leverage its capabilities.  Speak fluently on the unique merits and value of our proprietary test, positioning our differentiation from the competition.
•   Build deep relationships, educate and drive consensus across multiple stakeholders among both prospective and existing partners.
•   Develop a ‘trusted advisor’ relationship and establish oneself as fully accountable for demonstrating ROI to the partner account, ensuring both regular interaction and utilization review.
•   Secure contracts and agreements, where necessary or optimal, to memorialize long-term relationships with partners, define an exchange of value, and augment predictability into revenue.
•   Manage and secure renewals of partner agreements.
•   Collaborate with Sales, Marketing, and Product leadership to provide valuable market feedback, to inform all functions.
•   Partner, and co-present, with Karius’ Clinical/Medical Affairs teams (including Medical Science Liaisons) to support partner interactions, both remote and in-person, and manage follow-up.
•   Collaborate with Customer Success to onboard new accounts, share feedback, proactively address risks, immediately address concerns/problems, manage expectations, promote successes, and maintain close pulse on the health of the partner.
•   Partner with Marketing to identify and co-manage regional meeting opportunities, develop Key Opinion Leader (KOL) panels, and other local market activities.
•   Participate in broader sales meetings, training programs, conventions, and industry trade shows as required.
•   Complete paperwork and administrative duties in a timely and accurate fashion, including documentation in SalesForce, expense reporting, speaker program information, etc. 
 
What’s Fun About the Job?
Karius is operating at the edge of what is now known to be possible in infectious disease diagnostics. With that, comes a wave of new and incredible challenges and opportunities. To deliver on that value, you will be tapping into some of the most advanced technologies, architecting and innovating where the current solutions simply don't suffice. You will get to see how much your work really matters.
 
Travel:   Up to 70%.
 
Physical Requirements
Subject to extended periods of sitting and/or standing, vision to monitor and moderate noise levels. Work is generally performed remotely in the field.
 
Position Requirements
•   Bachelor’s degree; advanced degree or MBA a plus.
•   5 years of sales/business development experience in Life Sciences / Biotech, Medical Device, Diagnostic Equipment, and/or Pharmaceutical industries.
•   Valid driver's license. 
•   Previous success in introducing transformational, novel products or services to physicians and hospitals which have changed clinical practice prior to significant peer-reviewed publications or inclusion in guidelines for support.
•   Robust network of existing relationships in hospitals and health systems, across microbiology labs, send-out labs, physician groups, C-level executives, and administrators of clinical functions.
•   Strong vision and planning capabilities to grow the territory.
•   Excellent business acumen combined with outstanding analytical aptitude and problem-solving skills.
•   Strong ability to develop relationships from C-level executives to physicians and lab directors, building credibility through subject matter and industry expertise.
•   Demonstrated track record of top sales achievement, meeting and exceeding sales objectives.
•   Experience with multi-level account management.
 
Personal Qualifications
•   Entrepreneurial spirit and is comfortable multitasking and working in a fast-paced, ambiguous, growth-oriented environment.
•   Team player willing to collaborate with all customer facing teams to share best practices.
•   Ability to set priorities, allocate resources, take accountability and achieve results.
•   Strong presentation acumen and negotiation skills, ability to manage and facilitate engaging discussions with both small and large groups.
•   Unquestionable personal code of ethics, integrity, confidentiality and ability to build trusting and professional relationships.
•   Passionate about the mission and reputation of Karius while investing in the culture as the company grows.
 
Disclaimer
The above job description is intended to describe the general nature and level of work being performed by individuals assigned to this position. It is not intended to be an exhaustive list of all duties, responsibilities, and skills required. Responsibilities and duties may change or be adjusted to meet the needs of the company, and additional duties may be assigned as necessary. The job description is subject to change at any time at the discretion of Karius.
 
Equal Opportunity Employer
At Karius, we value a diverse and inclusive workplace and provide equal employment opportunities for all applicants and employees and are committed to honor and invest in the full diversity of people, in our hiring, recruiting and development of employees across the Company.  All qualified applicants for employment are encouraged to apply and will be considered without regard to an individual’s race, color, sex, gender identity and gender expression (including transgender individuals who are transitioning, have transitioned, or are perceived to be transitioning to the gender with which they identify), religion, age, national origin or ancestry, citizenship, physical or mental disability, medical condition, family care status, marital status, domestic partner status, sexual orientation, genetic information, military or veteran status, or any other basis protected by federal, state or local laws. If you are unable to submit your application due to a disability, please contact us at recruiting@kariusdx.com and we will accommodate qualified individuals with disabilities.