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Remote Utilization Review Rn Jobs in Washington, DC

Maximus

Clinical Nurse Consultant

VA · On-site +1

This is a remote opportunity. The Consultant manages the end-to-end medical review process ... Preferred Skills and Qualifications: - Valid, active LPN or RN license. - Experience working with ...

Manulife

Suitability Review Specialist

Washington, DC · Remote

$73K - $122K/yr

The Specialist serves as a trusted resource to registered representatives, field agents, and ... Referenced Salary Location USA, Massachusetts - Full Time Remote Working Arrangement Remote Salary ...

Sedgwick

RN Field Case Manager

Washington, DC · Remote

$88K - $112K/yr

... remote work environment that allows face to face interaction with injured workers and medical ... RN licensure required. Valid driver's license required. High speed internet required. Employment ...

Sedgwick

RN Field Case Manager

Fairfax, VA · Remote

$79K - $101K/yr

... remote work environment that allows face to face interaction with injured workers and medical ... RN licensure required. Valid driver's license required. High speed internet required. Employment ...

York Risk Services

RN Field Case Manager

Fairfax, VA · Remote

$79K - $101K/yr

... remote work environment that allows face to face interaction with injured workers and medical ... RN licensure required. Valid driver's license required. High speed internet required. Employment ...

York Risk Services

RN Field Case Manager

Washington, DC · Remote

$88K - $112K/yr

... remote work environment that allows face to face interaction with injured workers and medical ... RN licensure required. Valid driver's license required. High speed internet required. Employment ...

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Remote Utilization Review Rn information

See Washington, DC salary details

$24

$47

$78

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

As of Aug 14, 2026, the average hourly pay for remote utilization review rn in Washington, DC is $47.87, according to ZipRecruiter salary data. Most workers in this role earn between $37.84 and $55.00 per hour, depending on experience, location, and employer.

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

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What is a remote utilization review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

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

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

What are some common challenges remote utilization review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.

What are popular job titles related to Remote Utilization Review Rn jobs in Washington, DC?

For Remote Utilization Review Rn jobs in Washington, DC, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Rn jobs in Washington, DC look for?

The top searched job categories for Remote Utilization Review Rn jobs in Washington, DC are:

Remote Utilization Review Rn jobs near you
Infographic showing various Remote Utilization Review Rn job openings in Washington, DC as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $99,571 per year, or $47.9 per hour.

Physician Advisor (Remote)

UVA Health Northern VA & Culpeper

Manassas, VA • On-site, Remote

$250K - $350K/yr

Full-time

Posted 7 days ago

Job description


Physician Advisor (Remote)
Opportunity
UVA Health is seeking an experienced Physician Advisor to provide physician leadership across Utilization Management (UM), Clinical Documentation Integrity (CDI), Coding, and Case Management. This remote role focuses on medical necessity, regulatory compliance, documentation improvement, and advancing quality and operational outcomes. Join a dedicated and collaborative team that is valued by health system leadership for this unique skillset.
Key Responsibilities
  • Perform medical necessity reviews using MCG and/or InterQual
  • Support CMS compliance, including the 2-Midnight Rule and inpatient status determinations
  • Partner with Case Management, CDI, and physician teams to improve documentation and patient flow
  • Provide physician education, documentation feedback, and CDI query support
  • Conduct peer-to-peer reviews and assist with denial prevention and appeals
  • Participate in quality, compliance, and operational improvement initiatives

Position Highlights
  • Fully remote physician leadership opportunity (with the exception of 4 on-site meetings per year that are 1-day meetings)
  • Collaborate with multidisciplinary teams across UVA Health
  • Improve clinical documentation, utilization practices, and patient outcomes
  • Help shape system-wide initiatives in quality, compliance, and stewardship

Qualifications
  • MD or DO
  • Board Certified in Family Medicine, Internal Medicine or Pediatrics
  • Eligible for Virginia medical licensure
  • Prior Utilization Management experience preferred
  • Knowledge of CMS regulations and MCG/InterQual guidelines
  • Excellent communication and collaboration skills

The base compensation range for this role is $250,000 - $350,000 for a 1.0 clinical FTE status.
Individual compensation will be determined by fair market value and the selected candidate's qualifications, clinical experience, specialty training, credentials, and/or education. Please note that the pay range does not include any applicable incentive compensation programs, such as productivity, quality, non-productivity, or other incentives that may be available for eligible positions.
We are equal opportunity employers. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex, pregnancy, sexual orientation, veteran or military status, and family medical or genetic information.

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