Additional Information All your information will be kept confidential according to EEO guidelines.
Additional Information All your information will be kept confidential according to EEO guidelines.
New York RN license strongly preferred. * Minimum three (3) years of experience in workers' compensation, utilization review, case management, or occupational health. * Working knowledge of Workers ...
New
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New York RN license strongly preferred. * Minimum three (3) years of experience in workers' compensation, utilization review, case management, or occupational health. * Working knowledge of Workers ...
New
When necessary, cases are escalated to the Medical Director for further review. The reviewer ... Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred
When necessary, cases are escalated to the Medical Director for further review. The reviewer ... Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred
When necessary, cases are escalated to the Medical Director for further review. The reviewer ... Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred
When necessary, cases are escalated to the Medical Director for further review. The reviewer ... Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred
RN UTILIZATION REVIEW
Washington, DC · On-site
Additional Information All your information will be kept confidential according to EEO guidelines.
RN UTILIZATION REVIEW
Washington, DC · On-site
Additional Information All your information will be kept confidential according to EEO guidelines.
RN Utilization Review in Washington, DC
Washington, DC · On-site
$2.0K - $2.2K/wk
Now Hiring: RN Utilization Review - Washington, DC Job ID: JOB-412150 Weekly Pay Range: Contact us for Pay Information Weekly Pay Range: $2050.20-$2291.40wk Weekly pay ranges of $2050.20 - 2291.40 ...
RN Utilization Review in Washington, DC
Washington, DC · On-site
$2.0K - $2.2K/wk
Now Hiring: RN Utilization Review - Washington, DC Job ID: JOB-412150 Weekly Pay Range: Contact us for Pay Information Weekly Pay Range: $2050.20-$2291.40wk Weekly pay ranges of $2050.20 - 2291.40 ...
... review. It is within the BH UM Reviewer's discretion to retain requests for additional information ... Registered Nurse candidates: Associate Degree in Nursing required; Bachelor Degree in Nursing ...
... review. It is within the BH UM Reviewer's discretion to retain requests for additional information ... Registered Nurse candidates: Associate Degree in Nursing required; Bachelor Degree in Nursing ...
... review. It is within the BH UM Reviewer's discretion to retain requests for additional information ... Registered Nurse candidates: Associate Degree in Nursing required; Bachelor Degree in Nursing ...
... review. It is within the BH UM Reviewer's discretion to retain requests for additional information ... Registered Nurse candidates: Associate Degree in Nursing required; Bachelor Degree in Nursing ...
... review. It is within the BH UM Reviewer's discretion to retain requests for additional information ... Registered Nurse candidates: Associate Degree in Nursing required; Bachelor Degree in Nursing ...
... review. It is within the BH UM Reviewer's discretion to retain requests for additional information ... Registered Nurse candidates: Associate Degree in Nursing required; Bachelor Degree in Nursing ...
... review. It is within the BH UM Reviewer's discretion to retain requests for additional information ... Registered Nurse candidates: Associate Degree in Nursing required; Bachelor Degree in Nursing ...
... review. It is within the BH UM Reviewer's discretion to retain requests for additional information ... Registered Nurse candidates: Associate Degree in Nursing required; Bachelor Degree in Nursing ...
Additional Information All your information will be kept confidential according to EEO guidelines.
Additional Information All your information will be kept confidential according to EEO guidelines.
Utilization Mangement Technician
Washington, DC · On-site +1
$27.02 - $36.78/hr
Responsibilities: The Utilization Management Technician functions under the direction of the ... Compensation plans for physicians, licensed nurse reviewers, staff, and consultants who conduct ...
Utilization Mangement Technician
Washington, DC · On-site +1
$27.02 - $36.78/hr
Responsibilities: The Utilization Management Technician functions under the direction of the ... Compensation plans for physicians, licensed nurse reviewers, staff, and consultants who conduct ...
Utilization Review/Case Manager-Partial Hospitalization Program Department: Lanham Partial ... Evaluates data obtained in the bio-psychosocial and nursing history and assesses patients and their ...
Utilization Review/Case Manager-Partial Hospitalization Program Department: Lanham Partial ... Evaluates data obtained in the bio-psychosocial and nursing history and assesses patients and their ...
The Utilization Review Advisor (Advisor) position conducts timely and compliant medical necessity ... The Advisor interfaces directly with UR nurses and medical staff, providing concurrent ...
The Utilization Review Advisor (Advisor) position conducts timely and compliant medical necessity ... The Advisor interfaces directly with UR nurses and medical staff, providing concurrent ...
Associates Degree of Nursing * Current, full, active, and unrestricted license to practice as a ... Must have utilization management, utilization review or case management experience for 24 recent ...
Associates Degree of Nursing * Current, full, active, and unrestricted license to practice as a ... Must have utilization management, utilization review or case management experience for 24 recent ...
Associates Degree of Nursing * Current, full, active, and unrestricted license to practice as a ... Must have utilization management, utilization review or case management experience for 24 recent ...
Associates Degree of Nursing * Current, full, active, and unrestricted license to practice as a ... Must have utilization management, utilization review or case management experience for 24 recent ...
Associates Degree of Nursing * Current, full, active, and unrestricted license to practice as a ... Must have utilization management, utilization review or case management experience for 24 recent ...
Associates Degree of Nursing * Current, full, active, and unrestricted license to practice as a ... Must have utilization management, utilization review or case management experience for 24 recent ...
The Utilization Review Advisor (Advisor) position conducts timely and compliant medical necessity ... The Advisor interfaces directly with UR nurses and medical staff, providing concurrent ...
The Utilization Review Advisor (Advisor) position conducts timely and compliant medical necessity ... The Advisor interfaces directly with UR nurses and medical staff, providing concurrent ...
Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred ... Strong understanding of utilization review processes, including medical necessity criteria, care ...
Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred ... Strong understanding of utilization review processes, including medical necessity criteria, care ...
Clinical Care Reviewer UM
Washington, DC · On-site
Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred ... Strong understanding of utilization review processes, including medical necessity criteria, care ...
Clinical Care Reviewer UM
Washington, DC · On-site
Associate's Degree in Nursing (ASN) required; Bachelor's Degree in Nursing (BSN) preferred ... Strong understanding of utilization review processes, including medical necessity criteria, care ...
Utilization Review Nurse information
See Reston, VA salary details
$22.26 - $26.76
2% of jobs
$26.76 - $31.26
9% of jobs
$34.34 is the 25th percentile. Wages below this are outliers.
$31.26 - $35.76
21% of jobs
The median wage is $39.41 / hr.
$35.76 - $40.26
23% of jobs
$40.26 - $44.77
13% of jobs
$48.27 is the 75th percentile. Wages above this are outliers.
$44.77 - $49.27
10% of jobs
$49.27 - $53.77
8% of jobs
$53.77 - $58.27
5% of jobs
$58.27 - $62.77
5% of jobs
$62.77 - $67.27
2% of jobs
$67.27 - $71.77
2% of jobs
$22
$43
$71
How much do utilization review nurse jobs pay per hour?
As of Sep 3, 2026, the average hourly pay for utilization review nurse in Reston, VA is $43.99, according to ZipRecruiter salary data. Most workers in this role earn between $34.76 and $50.53 per hour, depending on experience, location, and employer.
What does a utilization review nurse do?
A Utilization Review Nurse is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, coordinate with healthcare providers, and ensure that care meets established guidelines and insurance requirements. Their primary goal is to ensure patients receive appropriate care while helping to manage healthcare costs and prevent unnecessary procedures.
What does a utilization review nurse do?
A utilization review nurse determines the best course of treatment for a patient using preapproved policy criteria. Utilization review nurses collect and review patient records, clinical documentation, and billing information to recommend the best use of patient care resources. Their assessments help determine the length of hospital stays, the effectiveness of the care plan, and the necessity of the services administered. Utilization review nurses inform and educate patients about their options based on their insurance benefits and limitations. Utilization review nurses also assess patient care services in clinical appeals for approval or denial.
What are some typical challenges utilization review nurses face when communicating with healthcare providers and insurance companies?
Utilization Review Nurses often need to balance clinical judgment with insurance guidelines, which can lead to challenging conversations with providers who may disagree with coverage decisions. They must clearly explain the rationale behind approvals or denials and ensure all documentation is thorough and compliant. Navigating differing priorities while maintaining positive, professional relationships is key, and strong communication skills help facilitate collaboration and resolve conflicts efficiently.
What are the key skills and qualifications needed to thrive as a utilization review nurse, and why are they important?
To thrive as a Utilization Review Nurse, you need a strong background in clinical nursing, critical thinking, and knowledge of healthcare regulations, usually supported by an RN license and nursing degree. Familiarity with utilization management software, medical coding systems (like ICD-10 and CPT), and case management certifications (such as CCM or URAC) is typically required. Excellent communication, negotiation, and organizational skills help you collaborate with providers and advocate for patient care while managing complex cases. These skills ensure appropriate resource use, regulatory compliance, and high-quality patient outcomes in healthcare settings.
What is the difference between Utilization Review Nurse vs Case Manager?
| Aspect | Utilization Review Nurse | Case Manager |
|---|---|---|
| Credentials | RN license, certification in utilization review (e.g., URAC) | RN license, case management certification (e.g., CCM) |
| Work Environment | Hospitals, insurance companies, healthcare facilities | Hospitals, insurance companies, community health settings |
| Employer & Industry Usage | Primarily in insurance and healthcare organizations for reviewing medical necessity | In healthcare and insurance for coordinating patient care and discharge planning |
Utilization Review Nurses focus on evaluating the necessity and appropriateness of medical services, often working in insurance or healthcare settings. Case Managers coordinate patient care, discharge planning, and resource management. While both roles require RN licensure and related certifications, their primary responsibilities differ: UR Nurses review medical necessity, whereas Case Managers facilitate patient care and services.
More about Utilization Review Nurse jobs
What are the most commonly searched types of Utilization Review Nurse jobs in Reston, VA?
The most popular types of Utilization Review Nurse jobs in Reston, VA are:
What are popular job titles related to Utilization Review Nurse jobs in Reston, VA?
For Utilization Review Nurse jobs in Reston, VA, the most frequently searched job titles are:
What job categories do people searching Utilization Review Nurse jobs in Reston, VA look for?
The top searched job categories for Utilization Review Nurse jobs in Reston, VA are:
What cities near Reston, VA are hiring for Utilization Review Nurse jobs?
Cities near Reston, VA with the most Utilization Review Nurse job openings:
Full-time
Re-posted 13 days ago
Job description
Additional Information
All your information will be kept confidential according to EEO guidelines.
About Korak Healthsource Group
Sourced by ZipRecruiter
Korak Healthsource Group Inc., looks beyond today’s challenges and creates values for the future. Today’s Claims Management clients need the organizational flexibility for all staffing solutions to drive cost savings, efficiencies improvements and enhancement to process effectiveness. Korak Healthsource is dedicated to developing innovative partnerships, creating customized staffing solutions, cost-effective and efficient health care claims administration outsourcing and support services to meet your business goals. Our focus is on your business goals to drive business process improvement, solution effectiveness and technology enhancements to accelerate results.
Industry
Recruiting and staffing services
Company size
11 - 50 Employees
Headquarters location
Forest Hill, MD, US
Year founded
1996