2

Remote Utilization Review Jobs in Washington, DC

Transition of Care RN

Washington, DC · Remote

$76K - $94K/yr

Experience with utilization review either in the hospital or with a managed care company, at least one year of experience in a medical office preferred. Experience working with Excel, Word and EMR ...

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

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

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

Senior Network Security Engineer

Suitland, MD · Remote

$63 - $82.50/hr

... reviews, recertification, cleanup, and decommissioning. * Install, configure, maintain, patch ... remote users, certificates, authentication policies, availability, utilization, and user access ...

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

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. · ...

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. · ...

TS/SCI Potential for Remote Work: ORA_ON_SITE Description SAIC is seeking experienced Principal ... Support readiness reviews and major program reviews to evaluate ground system readiness.

Showing results 21-40

Remote Utilization Review information

See Washington, DC salary details

$24

$47

$78

How much do remote utilization review jobs pay per hour?

As of Aug 14, 2026, the average hourly pay for remote utilization review in Washington, DC is $47.89, 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 in remote utilization review?

To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.

What does a remote utilization review do?

A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.

What is a remote utilization review?

A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.

What are the most commonly searched types of Utilization Review jobs in Washington, DC?

The most popular types of Utilization Review jobs in Washington, DC are:

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

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

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

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

Infographic showing various Remote Utilization Review job openings in Washington, DC as of August 2026, with employment types broken down into 83% Full Time, 11% Part Time, and 6% Contract. Highlights an 100% Remote job distribution, with an average salary of $99,608 per year, or $47.9 per hour.

Lead Researcher & SME - Forced Labor and Human Trafficking in Supply Chains

McColm and Company

Arlington, VA • Remote

$192K/yr

Contractor

Posted 2 days ago

New


Job description

Position: Lead Researcher and Subject Matter Expert (SME)

Engagement Type: Short Term Consultancy

Location: Fully Remote

Deadline: Rolling, position is open until filled

McColm & Company (McColm) is a mission-driven and customer-focused professional services firm that equips change makers with the knowledge, skills, and insights they need to succeed in an increasingly complex world. McColm specializes in supporting U.S. federal customers with national security, human services, foreign affairs, and emergency response-focused portfolios by managing bespoke professional training programs, delivering effective capacity building solutions, and providing highly specialized technical assistance and analysis expertise to decision makers.

McColm's Justice and Resilience Practice supports U.S. Government clients working to identify and mitigate forced labor and human trafficking risks globally. McColm seeks a subject matter expert to serve as the Lead Researcher and Subject Matter Expert (SME) for a Strategic Assessment and Gap Analysis project related to force labor and human trafficking in global supply chains.

The Lead Researcher will serve as the methodological lead for this project and is the principal author of study. The project combines structured stakeholder interviews and focus groups, stakeholder surveys, document and policy review, analysis of utilization data, and comparative benchmarking. Findings are triangulated across data sources to characterize operational, technical, policy, content, and capability gaps, and to inform prioritized, evidence-based recommendations on future-state operating, governance, and funding models.

The position is fully remote and requires virtual meetings and briefings with government personnel and stakeholders. The Lead Researcher coordinates closely with the U.S. Government client, a Senior Project Director, a supporting Investigator/SME, and lived experience expert reviewers.

This position is classed as a 1099 Independent Contractor.

Duties

The responsibilities of the Lead Researcher and SME include, but are not necessarily limited to, the following duties:

  • Serve as lead researcher and methodological lead for the assessment, drafting the methodology and tool development, including stakeholder mapping, sampling strategy, interview and focus group protocols, survey instruments, and the analytic framework.
  • Design and lead all data collection activities, including structured stakeholder interviews and focus groups, stakeholder surveys, document and policy review, and analysis of utilization data.
  • Lead comparative benchmarking analysis.
  • Triangulate qualitative and quantitative findings across data sources; identify operational, technical, policy, content, and capability gaps; and characterize evidence limitations and confidence levels with methodological transparency.
  • Draft substantive sections of the Draft and Final Strategic Assessment and Gap Analysis Reports, including current-state, governance, and sustainability assessments; utilization and comparative value findings; benchmarking observations; gap, risk, and maturity analysis; and future-state operating, governance, and funding options.
  • Coordinate closely with the Senior Project Director, a supporting Investigator/SME, and network consultant reviewers, and participate in periodic virtual meetings with government personnel and stakeholders.

Requirements

  • Advanced degree (Master's or higher preferred) in public policy, international relations, human rights, law, economics, social science research, or a related field, or equivalent professional experience.
  • Demonstrated subject matter expertise in responsible sourcing, supply chain due diligence, forced labor risk mitigation, and/or anti-trafficking policy, including familiarity with federal anti-trafficking procurement requirements.
  • Proven experience leading mixed-methods research or evaluations, including design of sampling strategies, interview and focus group protocols, and survey instruments, and triangulation of qualitative and quantitative data.
  • Experience conducting program assessments, evaluations, gap analyses, or strategic reviews for U.S. Government clients or comparable institutional clients.
  • Prior experience supporting U.S. Government clients through research.
  • Strong analytical writing skills, with demonstrated ability to produce evidence-based reports and actionable recommendations for senior government decision-makers.
  • Excellent stakeholder engagement and facilitation skills, including experience interviewing government, private sector, and lived experience stakeholders.
  • Experience applying trauma-informed and survivor-centered approaches in the overall research approach and when engaging with lived experience expert reviewers and stakeholders.
  • Experience with benchmarking or comparative analysis of digital tools or platforms, including governance, sustainability, and funding model assessment.
  • Strong experience using AI tools for data analysis.
  • Ability to work independently in a remote environment and manage competing deadlines across a phased workplan.

Benefits

Compensation is offered according to job requirements, market dynamics, and experience/skills of the successful candidate. Contract and consultant roles are not eligible for benefits.

We are an equal opportunity employer offering employment without regard to race, color, religion, sex, age, sexual orientation, national origin, citizenship, gender identity or expression, disability status, or any other characteristic protected by federal, state or local laws.

Due to the high volume of applications McColm receives and to ensure we comply with our internal hiring policies, we regret we are not able to respond to individual phone calls or emails regarding submission status.