ZipRecruiter

Log In

2

Remote Utilization Review Nurse Jobs in Springfield, VA

Amerihealth Caritas

UM Technician

Washington, DC · On-site +1

$27.02 - $36.78/hr

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet ... Compensation plans for physicians, licensed nurse reviewers, staff, and consultants who conduct ...

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 ...

previous page

Showing results 41-60

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

Remote Utilization Review Nurse information

See Springfield, VA salary details

$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.

More about Remote Utilization Review Nurse jobs

What are the most commonly searched types of Utilization Review Nurse jobs in Springfield, VA?

The most popular types of Utilization Review Nurse jobs in Springfield, VA are:

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

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

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

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

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

Cities near Springfield, 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 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.

PEER REVIEWER - ANESTHESIOLOGY - REMOTE

iMPROve Health

Washington, DC • Remote

Contractor

Posted 24 days ago

Job description

iMPROve Health is seeking a Anesthesiologist 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.

DUTIES AND RESPONSIBILITIES:

  • Conduct objective, evidence-based peer reviews of clinical cases.
  • Make final determinations regarding medical necessity and quality of care.
  • Ensure decisions are fair, unbiased, and aligned with current standards of practice.
  • Submit reviews in a timely and professional manner using the IT systems provided.

QUALIFICATIONS:

  • Medical License: Must hold an unrestricted medical license in any U.S. state.
  • Board Certification: Required (if applicable), through a board recognized by:
    • The American Board of Medical Specialties (ABMS),
    • The American Osteopathic Association (AOA), or
    • Another nationally recognized board granting certification.
  • Clinical Experience:
    • Have at least five (5) years full-time equivalent experience providing direct clinical care to patients.
    • Have experience providing direct clinical care to patients within the past three (3) years.
    • Knowledgeable of the issue under review, or of the current, evidence-based clinical guidelines and novel treatments for the medical or behavioral health condition, disease, treatment, or procedure under review.
    • Have the clinical expertise to manage the medical or behavioral health condition or disease under review.
    • Must be actively engaged in direct or virtual patient care for at least 20 hours per week. Administrative work does not qualify.

TECHNOLOGY REQUIREMENTS:

  • Reliable Wi-Fi access.
  • Proficiency with Microsoft Word.
  • Access to a computer compatible with iMPROve Health’s IT systems.

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.
  • Cannot have current employment or affiliation with any Veterans Affairs (VA) hospital, health care system, or medical center if applying to perform VA-related peer reviews.

EOE/VET/Disability