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Utilization Management Jobs in Reston, VA (NOW HIRING)

Evolent

Internal Medicine Physician

Arlington, VA

As a FMD, Radiology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can ...

Evolent

Radiology Physician

Arlington, VA

$368K - $460K/yr

As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy ...

UHS

Utilization Review Coordinator

Washington, DC · On-site

$33.60 - $50.40/hr

Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...

UHS

Utilization Review Coordinator

Washington, DC · On-site

Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...

UHS

Utilization Review Coordinator

Washington, DC

Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...

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All JobsUtilization Management JobsUtilization Management Jobs in Reston, VA

Utilization Management information

See Reston, VA salary details

$40.6K

$93.3K

$169.9K

How much do utilization management jobs pay per year?

As of Jul 22, 2026, the average yearly pay for utilization management in Reston, VA is $93,253.00, according to ZipRecruiter salary data. Most workers in this role earn between $67,200.00 and $108,900.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Utilization Management position, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What is a Utilization Management job?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What are the typical daily responsibilities of a Utilization Management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

What are the most commonly searched types of Utilization Management jobs in Reston, VA? The most popular types of Utilization Management jobs in Reston, VA are:
What are popular job titles related to Utilization Management jobs in Reston, VA? For Utilization Management jobs in Reston, VA, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Reston, VA look for? The top searched job categories for Utilization Management jobs in Reston, VA are:
What cities near Reston, VA are hiring for Utilization Management jobs? Cities near Reston, VA with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Reston, VA as of July 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 1% Temporary, and 3% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $93,253 per year, or $44.8 per hour.
Utilization Management Reviewer

Utilization Management Reviewer

Amerihealth Caritas

Washington, DC • On-site, Remote

Full-time

Medical, Retirement, PTO

Posted yesterday

New

Job description

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We are looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. We want to connect with you if you want to make a difference. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Discover more about us at www.amerihealthcaritas.com.

Role Overview

Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient services, ensuring treatment aligns with clinical guidelines, regulatory requirements, and patient needs. This role requires reviewing provider requests, gathering necessary medical documentation, and making determinations based on clinical criteria. Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of services, identifies care coordination opportunities, and ensures compliance with medical policies. When necessary, cases are escalated to the Medical Director for further review. The reviewer independently applies medical and behavioral health guidelines to authorize services, ensuring they meet the patient’s needs in the least restrictive and most effective manner.

Work Arrangement

  • Monday through Friday from 8:30 AM EST to 5:00 PM EST; 2 days must be worked in our DC office located at 1201 Maine Ave SW and 3 days can be worked remotely
  • Must work 4 recognized company holidays to include Thanksgiving and Christmas (rotating)
  • Weekends and overtime based on business need

Responsibilities

  • Conduct utilization management reviews by assessing medical necessity, appropriateness of care, and adherence to clinical guidelines
  • Collaborate with healthcare providers to facilitate timely authorizations and optimize patient care
  • Analyze medical records and clinical data to ensure compliance with regulatory and payer guidelines
  • Communicate determinations effectively, providing clear, evidence-based rationales for approval or denial decisions
  • Identify and escalate complex cases requiring physician review or additional intervention
  • Ensure compliance with industry standards, including Medicare, Medicaid, and private payer requirements
  • Maintain productivity and efficiency by meeting established performance metrics, turnaround times, and quality standards in a high-volume environment

Education & Experience

  • Associate’s Degree in Nursing (ASN) required; Bachelor’s Degree in Nursing (BSN) preferred
  • Minimum of 3 years of diverse independent clinical practice experience as a Registered Nurse in outpatient surgery, Medical-Surgical, Critical Care, Skilled Nursing Facility (SNF), Rehabilitation, or Long-Term Acute Care (LTAC) settings
  • Experience applying evidence-based criteria (e.g. InterQual) to complete prior authorization and concurrent reviews for inpatient, outpatient and/or post acute services
  • Experience conducting utilization management reviews specific to a Medicare population across multiple states for a payer preferred

Licensure

  • An active and unencumbered Registered Nurse (RN) license in the District of Columbia required

Skills and Abilities

  • Competency in electronic health record (EHR) documentation and charting
  • Proficiency using MS Office to include Word, Excel, Outlook and Teams
  • Strong understanding of utilization review processes, including medical necessity criteria, care coordination, and regulatory compliance
  • Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment
  • Maintains a strong working knowledge of federal, state, and organizational regulations to ensure consistent application in the review process
  • Ability to type with accuracy and speed

Our Comprehensive Benefits Package

Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k), tuition reimbursement, and more.

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