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Remote Utilization Review Nurse Jobs in Reston, VA

McGuireWoods LLP

Director, Benefits

Washington, DC · On-site +1

  • Medical

  • Dental

  • Retirement

Along with excellent benefits, McGuireWoods offers most employees a hybrid remote option allowing ... Lead the annual benefits renewal process, including plan design evaluation, utilization review ...

McGuireWoods LLP

Director, Benefits

Washington, DC · On-site +1

  • Medical

  • Dental

  • Retirement

Along with excellent benefits, McGuireWoods offers most employees a hybrid remote option allowing ... Lead the annual benefits renewal process, including plan design evaluation, utilization review ...

Centerbrite Health

BCBA (Part-time)

Fairfax, VA · On-site +1

$80 - $110/hr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

... Hybrid (Remote + In-person) A rare opportunity to join a growing ABA practice as an early team ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...

Centerbrite Health

BCBA

Fairfax, VA · On-site +1

$90K - $110K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ... Remote and in-clinic Job Types: Full-time

Sentara Healthcare

Nurse Case Manager-NOVA, VA

Manassas, VA · On-site +1

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... efficient utilization of health benefits; conducts gap in care management for quality programs ... For positions that are available as remote work, Sentara Health employs associates in the following ...

Maximus

Clinical Nurse Consultant

VA · On-site +1

  • Medical

  • Life

  • Retirement

  • PTO

General information Job Posting Title Clinical Nurse Consultant Date Monday, August 10, 2026 City ... This is a remote opportunity. The Consultant manages the end-to-end medical review process ...

Sasaki Evolutionary Integration Services (SEIS), LLC

Be Seen First

Software Development Engineer III - Remote

Chantilly, VA · Remote

$130K - $157K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... Review and approve technical designs and code produced by other engineers. Advanced Development ... utilization. · Collaborate with software developers, business analysts, project managers, and ...

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All JobsUtilization Review Nurse JobsRemote Utilization Review Nurse JobsRemote Utilization Review Nurse Jobs in Reston, VA

Remote Utilization Review Nurse information

See Reston, VA salary details

$22

$43

$71

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

As of Aug 17, 2026, the average hourly pay for remote utilization review nurse 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 is a remote utilization review nurse?

A Remote Utilization Review Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments, typically from a remote location such as their home. They review patient medical records, apply clinical guidelines, and collaborate with providers and insurance companies to ensure patients receive appropriate care while managing healthcare costs. This role often involves making coverage determinations, conducting pre-authorizations, and participating in appeals processes. Remote Utilization Review Nurses play a critical role in improving patient outcomes and resource allocation within the healthcare system.

What does a remote utilization review nurse do?

As a remote utilization nurse, your duties are to work from home or a remote location to review patient medical records and prepare a range of paperwork for different types of actions a hospital or health care provider can take. Your responsibilities are to determine patient coverage, carry out denial of service authorizations, and negotiate different treatment options and hospital stay length for patients. You rely on your knowledge of treatment options and diseases to determine the level of appropriate care for a patient. Because you telecommute, you also need good technical skills.

What are the key skills and qualifications needed to thrive as a remote utilization review nurse?

To thrive as a Remote Utilization Review Nurse, you need a current RN license, clinical experience, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, EHR systems, and certifications like CCM or URAC are highly valued. Strong analytical thinking, attention to detail, and effective communication skills enable success in evaluating clinical documentation and collaborating with providers remotely. These skills and qualifications are essential to ensure efficient, compliant care decisions that optimize patient outcomes and resource use.

How does a remote utilization review nurse collaborate with physicians and other healthcare team members while working remotely?

As a Remote Utilization Review Nurse, collaboration with physicians, case managers, and other healthcare professionals is primarily conducted through secure digital platforms such as email, video conferencing, and electronic health record systems. Effective communication is essential to discuss patient care plans, clarify medical necessity, and ensure compliance with utilization policies. Nurses in this role often participate in virtual meetings or case conferences to present findings and recommendations. Building strong working relationships remotely requires proactive communication, responsiveness, and familiarity with digital collaboration tools.

What is the difference between Remote Utilization Review Nurse vs Remote Case Manager?

AspectRemote Utilization Review NurseRemote Case Manager
CertificationsRN license, possibly CCM or UR certificationsRN license, CCM or case management certifications
Work EnvironmentHealthcare facilities, insurance companies, telehealthInsurance companies, healthcare organizations, telehealth
Job FocusReview medical necessity, approve or deny servicesCoordinate patient care, arrange services, discharge planning

Remote Utilization Review Nurses primarily evaluate medical necessity for services, while Remote Case Managers coordinate patient care and discharge planning. Both roles require nursing credentials and work in healthcare or insurance settings, but their core responsibilities differ. Understanding these distinctions helps job seekers find the best fit for their skills and career goals.

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

Remote Utilization Review Nurse jobs near you
Infographic showing various Remote Utilization Review Nurse job openings in Reston, VA as of August 2026, with employment types broken down into 54% Full Time, 23% Part Time, and 23% Contract. Highlights an 100% Remote job distribution, with an average salary of $91,496 per year, or $44 per hour.

Integrated Care Manager/ Registered Nurse (RN) LTSS Waiver Members/Medicaid - Remote in NOVA (Fairfa

Sentara Healthcare

Alexandria, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 26 days ago

Sentara Health rating

6.7

Company rating: 6.7 out of 10

Based on 412 frontline employees who took The Breakroom Quiz

531st of 887 rated healthcare providers

Job description

City/State
Fairfax, VA
Work Shift
First (Days)
Overview:
Sentara Health Plans is hiring an Integrated Care Manager/ Registered Nurse (RN) LTSS Waiver Members/Medicaid - Remote in NOVA (Fairfax, Springfield and Alexandria, VA) and the surrounding areas!
Status: Full-time, permanent position (40 hours)
Standard working hours: 8 am to 5 pm EST, M-F
The position requires in person/face-to-face assessments with remote/home office for the Long-Term Services and Supports (LTSS) Waiver Members/Medicaid in Northern Virginia (Fairfax, Springfield, and Alexandria, VA), and the surrounding areas! May travel up to 1 hour max.
Location: Candidate must reside in Northern Virginia (Fairfax, Springfield, and Alexandria, VA), and the surrounding areas
Job responsibilities:
  • Responsible for case management services within the scope of licensure; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum
  • Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical and behavioral health, social services and long-term services
  • Identifies members for high-risk complications and coordinates care in conjunction with the member and health care team
  • Manages chronic illnesses, co-morbidities, and/or disabilities ensuring cost effective and efficient utilization of health benefits; conducts gap in care management for quality programs
  • Assists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible
  • Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans
  • Presents cases at case conferences for multidisciplinary focus. Ensures compliance with regulatory, accrediting and company policies and procedures
  • May assist in problem solving with provider, claims or service issues.

Education:
  • BLD - Bachelor's Level Degree in Nursing preferred

Certification/Licensure:
  • Registered Nurse (RN) License (Compact or Virginia) REQUIRED

Experience:
  • 3 years experience in Nursing REQUIRED
  • Managed Care/ Health Plan/ Health Insurance experience highly preferred
  • Case Management experience preferred
  • Long-Term Services and Supports (LTSS) waiver and Home Health experience preferred
  • Behavioral Health experience is secondary

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products, including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs, and plans serving Medicare and Medicaid enrollees.
Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.
We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services-all to help our members improve their health.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-103241
Talroo - Health Plan
Keywords: Medicaid, Managed Care, Health Plan, Health Insurance, MCO, Integrated Case Manager, Registered Nurse, RN, Nursing, Fairfax, Springfield, and Alexandria, VA, Northern Virginia, NOVA, Long-Term Services and Supports (LTSS), Waiver, Home Health
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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