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Remote Utilization Review Nurse Jobs in Springfield, VA

Centerbrite Health

BCBA

Fairfax, VA · On-site +1

$90K - $110K/yr

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

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Remote Utilization Review Nurse information

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$22

$44

$72

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

As of Sep 7, 2026, the average hourly pay for remote utilization review nurse 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 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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The top searched job categories for Remote Utilization Review Nurse jobs in Springfield, VA are:

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Remote Utilization Review Nurse jobs near you
Infographic showing various Remote Utilization Review Nurse job openings in Springfield, VA as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 18% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $91,862 per year, or $44.2 per hour.

Workers Compensation - Telephonic Nurse Case Manager (Remote)

Berkley

Manassas, VA • On-site, Remote

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 9 days ago

Job description

Company Details
Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker's successful and speedy return to work is good for people and good for Berkley's insurance operating units. BMMS was first started in 2014 by reimagining the relationship between medical need and technology to deliver the best outcome for injured workers and Berkley's operating units. Our goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers' compensation cases.
To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and continued innovation. We deploy integrated systems to give W.R. Berkley Companies recommendations and professional services for managing each individual case in an efficient and appropriate manner. The power of our technology takes medical bill-review services and clinical advisory services to a new level. Our unique marriage of technology, software platforms, data analytics and professional services ensures we provide Berkley's operating units with reliable results, and reduced time and expenses associated with case management.
Responsibilities
As a Telephonic Nurse Case Manager, you will assess, plan, coordinate, monitor, evaluate and implement options and services to facilitate timely medical care and return to work outcomes of injured workers.
  • Coordinate and implement medical case management to facilitate case closure
  • Timely and comprehensive communication with with employers, adjusters and the injured workers.
  • Assess appropriate utilization of medical treatment and services available through contact with physicians and other specialist to ensure cost effective quality care
  • Review and analyze medical records and assess data to ensure appropriate case management process occurs while providing recommendations to achieve case progress and movement to closure
  • Responsible for assigned caseloads, which may vary in numbers, territory and/or by state jurisdiction
  • Acquire and maintain nursing licensure for all jurisdictions as business needs require
  • Coordinate services to include home services, durable medical equipment, IMEs, admissions, discharges, and vocational services when appropriate and evaluate cost effectiveness and quality of services
  • Document activities and case progress using appropriate methods and tools following best practices for quality improvement
  • Reviewing job analysis/job description with all providers to coordinate and implement disability case management. This includes coordinating job analysis with employer to facilitate return to work.
  • Engage and participate in special projects as assigned by case management leadership team
  • Occasionally attend on site meetings and professional programs
  • Foster a teamwork environment
  • Maintaining and updating evidence based medical guidelines (such as Official Disability Guidelines, MD Guidelines and all required state regulated guidelines) in reference to the injured worker treatment plan and work status.
  • Obtain and maintain applicable state certifications and/or licensures in the state where job duties are performed.
  • Obtain case management professional certification (CCM) within 2 years of hire date
  • Earn Continuing Education Units to maintain certifications and licensures

Qualifications
  • Minimum 2 years of experience in workers compensation insurance and medical case management preferred
  • Minimum of 4 years medical/surgical clinical experience required
  • Exhibit strong communication skills, professionalism, flexibility and adaptability
  • Possess working knowledge of medical and vocational resources available to the Workers' Compensation industry
  • Demonstrate evidence of self-motivation and the ability to perform case management duties independently
  • Demonstrate evidence of computer and technology skills
  • Oral and written fluency in both Spanish and English a plus

Education
  • Graduate of an accredited school of nursing and possess a current RN license.
  • *RN compact license preferred, CCM preferred, Bachelor of Nursing preferred*

Additional Company Details
*The above job description is not intended to be an "all-inclusive" list of the duties and responsibilities of the job described, nor is it intended to be such a listing of the skills and abilities required to do the job. Rather, it is intended only to describe the general nature of the job.
The Company is an equal employment opportunity employer.
We do not accept any unsolicited resumes from external recruiting agencies or firms.
The company offers a competitive compensation plan and robust benefits package for full time regular employees
• Benefits: Health, Dental, Vision, Life, Disability, Wellness, Paid Time Off, 401(k) and Profit-Sharing plans.
- Base Salary Range: 75k-88k
The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment.
Additional Requirements
Domestic U.S. travel required (up to 10% of time)
Sponsorship Details
Sponsorship not Offered for this Role

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