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Remote Utilization Management Jobs in Reston, VA

3Y

Occupational Therapy Consultant

Washington, DC · Remote

$320K/yr

... utilization-management processes is a plus. * Passion for expanding equitable occupational therapy care and experimenting with outcome-driven models. * Enjoys autonomy and remote, flexible ...

3Y

Occupational Therapy Consultant

Washington, DC · Remote

$320K/yr

... utilization-management processes is a plus. * Passion for expanding equitable occupational therapy care and experimenting with outcome-driven models. * Enjoys autonomy and remote, flexible ...

Citizant

PMO / Management Analyst

Washington, DC · Remote

$158.50K - $159.10K/yr

Remote (with occasional onsite support as required) Key Responsibilities Program Support * Support ... Track program risks, dependencies, and resource utilization, ensuring issues are proactively ...

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Remote Utilization Management information

See Reston, VA salary details

$22

$43

$71

How much do remote utilization management jobs pay per hour?

As of May 30, 2026, the average hourly pay for remote utilization management 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 Remote Utilization Management Nurse, and why are they important?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

How does a Remote Utilization Management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

What are the most commonly searched types of Utilization Management jobs in Reston, VA? The most popular types of Utilization Management jobs in Reston, VA are:
What are popular job titles related to Remote Utilization Management jobs in Reston, VA? For Remote Utilization Management jobs in Reston, VA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Reston, VA look for? The top searched job categories for Remote Utilization Management jobs in Reston, VA are:
What cities near Reston, VA are hiring for Remote Utilization Management jobs? Cities near Reston, VA with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Reston, VA as of May 2026, with employment types broken down into 5% As Needed, 15% Full Time, 70% Part Time, and 10% Contract. Highlights an 89% Physical, and 11% Remote job distribution, with an average salary of $91,496 per year, or $44 per hour.
PRN Clinical Reviewer - Substance Use (LPCC, LMFT, LICSW)

PRN Clinical Reviewer - Substance Use (LPCC, LMFT, LICSW)

Acentra Health

Mclean, VA • Remote

$28.37 - $39.19/hr

Per diem

Medical, Retirement

Posted 3 days ago

Acentra Health rating

6.3

Company rating: 6.3 out of 10

Based on 15 frontline employees who took The Breakroom Quiz

161st of 203 rated it services

Job description

Company Overview Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Job Summary Clinical Reviewer – Substance Use – LPCC, LMFT, LICSW – PRN (Remote U.S.) Responsible for reviewing and interpreting patient records against American Society of Addiction Medicine (ASAM) criteria to determine medical necessity and appropriateness of care.

Manage workload, attend training, maintain accuracy and timeliness, monitor quality, and serve as liaison with providers and internal customers. Responsibilities Review and interpret patient records against ASAM criteria to determine medical necessity and appropriateness of care. Attend training and scheduled meetings; maintain and use current/updated information for review.

Ensure accuracy and timeliness of all applicable review type cases within contract requirements. Assess, evaluate, and address daily workload and queues; adjust work schedules daily to meet workload demands. Collaborate with Supervisor to conduct quality monitoring activities, identify areas of improvement, and implement improvement plans.

Maintain current knowledge base related to review processes and clinical practices. Act as provider liaison and resource person for provider customer service issues and problem resolution. Build positive and professional relationships with internal and external customers to facilitate the review process.

Read, understand, and adhere to all corporate policies, including HIPAA Privacy and Security Rules. Required Qualifications Active, unrestricted license in the state of Minnesota in one of the following areas: LPCC, LMFT, or LICSW. 3+ years of experience providing direct clinical work as a mental health professional across diverse settings.

1+ years of Utilization Review (UR) or Utilization Management (UM) or Prior Authorization experience. In-depth understanding of ASAM criteria and its practical application in clinical environments. Familiarity with medical records structure, terminology, and disease processes.

Strong clinical assessment capabilities paired with excellent critical thinking. Proficient in medical record abstraction. Must attend Monday orientation (or next business day if holiday).

Preferred Qualifications Proficiency in Microsoft Office 365 applications (Word, Excel, Outlook, Teams). Excellent written and verbal communication skills. Demonstrated ability to manage deadlines, prioritize tasks, and thrive in a fast‐paced environment.

Highly organized with meticulous attention to detail. Benefits Access to select Acentra Health benefits and programs, such as 401(k) plan with company match, wellness and employee discount programs, and Employee Assistance Program (EAP) resources. Compensation USD $28.37 – $39.19 per hour.

EEO Statement Acentra Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, national origin, disability, status as a protected veteran or any other status protected by applicable federal, state or local law. #J-18808-Ljbffr

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