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Remote Utilization Review Nurse Jobs in Reston, VA

Koniag, Inc.

FinOps Specialist (REMOTE)

Washington, DC · On-site +1

... variances, utilization, forecast changes, material issues, and risks. * Monitor cloud budgets ... for review and disposition. * Participate in Agile or program-management ceremonies, including ...

kgs

FinOps Specialist (REMOTE)

Washington, DC · Remote

... variances, utilization, forecast changes, material issues, and risks. * Monitor cloud budgets ... for review and disposition. * Participate in Agile or program-management ceremonies, including ...

kgs

FinOps Specialist (REMOTE)

Washington, DC · Remote

... variances, utilization, forecast changes, material issues, and risks. * Monitor cloud budgets ... for review and disposition. * Participate in Agile or program-management ceremonies, including ...

Bcbsa

Director, Trade Client Relations

Gaithersburg, MD · Remote

$155K - $175K/yr

Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy ... Clinical Team - Liaise with Clinical team to review clinical data and policy requirements as needed

AvantGarde, LLC

Program Manager

Washington, DC · On-site +1

Remote work options are available after a brief acclimation period. Essential Duties and ... reviews, and governance audits to identify risks, trends, and opportunities for improvement. · ...

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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 16, 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 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.

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.

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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.

Physician Assistant/Nurse Practitioner

Central Intelligence Agency

Washington, DC • On-site, Remote

$133K - $158K/yr

Full-time

Posted 26 days ago

Job description

Summary
Physician Assistants/Nurse Practitioners work with highly motivated individuals to deliver medical care in challenging and unique settings.
Learn more about this agency
Duties
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  • As a Physician Assistant/Nurse Practitioner for CIA, you will work with highly motivated individuals to deliver quality healthcare in challenging and austere environments with limited resources. Your duties will include:
  • Treating illness, injuries, and medical emergencies to include trauma stabilization
  • Establishing and operating remote independent duty clinics including performing logistical and administrative functions.
  • Conducting physical examinations and interpretation of diagnostic testing
  • Providing didactic and practical instruction in various levels of medical care to include field medicine, and Tactical Combat Casualty care.

You will be required to carry medical equipment from one location to another on foot in austere foreign environments and may work with host-country personnel, often as the sole provider. You should be comfortable operating independently with a minimal amount of key medical supplies and without direct physician oversight.
While the initial assignment is located in the Washington, DC area, candidates will become part of a deploying team serving abroad in various locations for the beginning of their career. All candidates will be required to serve a one-year unaccompanied assignment at some point, but will also have the opportunity to relocate with immediate family to an assorted choice of locations abroad to serve in a more clinical setting.
As part of our team, you will receive excellent benefits and a variety of medical and non-medical training will be provided. You will be eligible for an annual retention bonus of 10% of base pay after completing 12 months of qualifying service, based on annual review. Additional incentive pay is possible based on assignment and duties.
Requirements
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Conditions of employment
  • You must be physically in the United States or one of its territories when you submit your resume via MyLINK.
  • You must be registered for the Selective Service, if applicable.
  • You must be a U.S. citizen and at least 18 years of age (dual-national US citizens are eligible).
  • You must be willing to move to the Washington, DC area.
  • You must successfully complete a thorough medical and psychological exam, a polygraph interview, and a comprehensive background investigation.
  • For further information, please visit: https://www.cia.gov/careers/how-we-hire/

Qualifications
Minimum Qualifications
Interested candidates should be passionate about the ideals of our American republic, committed to upholding the rule of law and the U.S. Constitution, and committed to improving the efficiency of the Federal government. Hiring decisions will not be based on race, sex, color, religion, or national origin.
  • Five years of relevant experience working as a Physician Assistant or Nurse Practitioner to include military service, civilian emergency medicine department, or extensive experience practicing in remote or austere environments.
  • Excellent interpersonal and communications skills
  • Ability to meet the minimum requirements for joining CIA, including U.S. citizenship and a background investigation

Desired Qualifications:
  • Military service
  • Strong interest in international affairs
  • Foreign language proficiency

Education
  • Master's degree from an AAPA-approved program and/or NP program
  • Current NCCPA certification for PAs, AANPCB or ANCC certification for NPs including ability to practice in a full-scope primary care/acute care setting

Additional information
Candidates should be committed to improving the efficiency of the Federal government, passionate about the ideals of our American republic, and committed to upholding the rule of law and the United States Constitution.
Benefits
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A career with the U.S. government provides employees with a comprehensive benefits package. As a federal employee, you and your family will have access to a range of benefits that are designed to make your federal career very rewarding. Opens in a new windowLearn more about federal benefits.
Review our benefits
Eligibility for benefits depends on the type of position you hold and whether your position is full-time, part-time or intermittent. Contact the hiring agency for more information on the specific benefits offered.

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