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Remote Utilization Review Nurse Practitioner Jobs in Reston, VA

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Remote Utilization Review Nurse Practitioner information

See Reston, VA salary details

$73.9K

$139.8K

$219K

How much do remote utilization review nurse practitioner jobs pay per year?

As of Sep 3, 2026, the average yearly pay for remote utilization review nurse practitioner in Reston, VA is $139,791.00, according to ZipRecruiter salary data. Most workers in this role earn between $115,500.00 and $158,700.00 per year, depending on experience, location, and employer.

What is a remote utilization review nurse practitioner?

A Remote Utilization Review Nurse Practitioner is a licensed advanced practice nurse who evaluates the necessity, efficiency, and appropriateness of healthcare services, treatments, and hospital admissions, typically from a remote or home-based setting. They review patient medical records to ensure care meets established guidelines and insurance requirements, helping to control costs and ensure quality care. Their role often involves collaborating with physicians, insurance companies, and healthcare facilities to determine coverage and recommend alternative treatments when necessary. Working remotely, they rely heavily on electronic health records and telecommunication tools to perform their duties.

How does a remote utilization review nurse practitioner typically collaborate with healthcare teams while working offsite?

Remote Utilization Review Nurse Practitioners frequently collaborate with interdisciplinary teams through virtual meetings, secure messaging platforms, and electronic health record (EHR) systems. They work closely with physicians, case managers, and insurance representatives to review patient care plans, ensure medical necessity, and support appropriate resource utilization. Despite working remotely, maintaining clear communication and timely documentation is essential for seamless coordination and decision-making. Many organizations provide robust digital tools and regular team check-ins to facilitate collaboration and support remote staff.

What are the key skills and qualifications needed to thrive as a remote utilization review nurse practitioner, and why are they important?

To thrive as a Remote Utilization Review Nurse Practitioner, you need an advanced nursing degree (NP), active state licensure, and strong knowledge of clinical guidelines and insurance criteria. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications such as CCM (Certified Case Manager) are often required. Critical thinking, strong communication, and a detail-oriented approach set top performers apart in this remote role. These skills ensure accurate, compliant, and efficient review of patient care while supporting healthcare cost management and patient advocacy.

What is the difference between Remote Utilization Review Nurse Practitioner vs Telehealth Nurse Practitioner?

AspectRemote Utilization Review Nurse PractitionerTelehealth Nurse Practitioner
CertificationsNP license, possibly certification in utilization reviewNP license, general telehealth certifications
Work EnvironmentReviewing medical records, insurance data remotelyProviding patient care via telehealth platforms
Employer & IndustryInsurance companies, healthcare organizationsHospitals, clinics, telehealth companies

The main difference is that Remote Utilization Review Nurse Practitioners focus on reviewing medical necessity and insurance claims remotely, while Telehealth Nurse Practitioners provide direct patient care via telehealth platforms. Both roles require NP licensure, but their daily tasks and work environments differ significantly.

What are popular job titles related to Remote Utilization Review Nurse Practitioner jobs in Reston, VA?

For Remote Utilization Review Nurse Practitioner jobs in Reston, VA, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Nurse Practitioner jobs in Reston, VA look for?

The top searched job categories for Remote Utilization Review Nurse Practitioner jobs in Reston, VA are:

What cities near Reston, VA are hiring for Remote Utilization Review Nurse Practitioner jobs?

Cities near Reston, VA with the most Remote Utilization Review Nurse Practitioner job openings:

Remote Utilization Review Nurse Practitioner jobs near you
Infographic showing various Remote Utilization Review Nurse Practitioner job openings in Reston, VA as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 17% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $139,791 per year, or $67.2 per hour.

RN Reviewer/ Workers' Compensation Utilization Review - REMOTE

MICHIGAN PEER REVIEW ORGANIZATION

Washington, DC • Remote

Contractor

Posted yesterday

New

Job description

iMPROve Health is seeking an RN Reviewer (Workers' Compensation Utilization Review) to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis.  As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type.

BENEFITS:

  • Make a Difference: Use your clinical knowledge to improve the quality of care patients receive.
  • Professional Recognition: Join a network of highly respected experts in your specialty.
  • Competitive Compensation: Receive fair pay for your time and expertise.
  • Protect Standards of Care: Help uphold the integrity of your profession.
  • Work Remotely: Review cases from the convenience of your home or office.
Qualifications

  • Active, unrestricted RN license required; New York RN license strongly preferred.
  • Minimum three (3) years of experience in workers' compensation, utilization review, case management, or occupational health.
  • Working knowledge of Workers' Compensation Medical Treatment Guidelines and evidence-based clinical criteria.
  • Strong clinical assessment, critical thinking, and written communication skills.
  • Experience reviewing medical records and determining medical necessity preferred.

Responsibilities

  • Review treatment requests and medical records for medical necessity and guideline compliance.
  • Apply Workers' Compensation Medical Treatment Guidelines and applicable regulatory requirements.
  • Prepare clear, objective, and timely review determinations.
  • Maintain confidentiality and comply with HIPAA and other applicable privacy requirements.

Technical Requirements

  • Reliable high-speed internet/Wi-Fi connection.
  • Secure home office environment with the ability to protect confidential information.
  • Proficiency using web-based review platforms and Microsoft Office applications.

OTHER REQUIREMENTS:

  • Must complete the electronic credentialing application and receive organizational approval prior to performing a case review.
  • Must complete a conflict of interest attestation upon credentialing and prior to performing a case review.
  • Active hospital medical staff privileges may be required, as applicable.
  • Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status.

EOE/VET/Disability