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Utilization Review Nurse Jobs in Reston, VA (NOW HIRING)

Greenlife Healthcare Staffing

Be Seen First

Registered Nurse I

Washington, DC · On-site

$52/hr

Registered Nurse I - Washington, DC (#R10290) * Location: Washington, DC 20001 * Employment Type ... Clinical experience in orthopedics, neurology, rehabilitation, or utilization review. * Skills:

The Excalibur Group

Registered Nurse I

Washington, DC · On-site

Registered Nurse I Location: Washington, DC About the Role: The Registered Nurse I provides ... Clinical experience in orthopedics, neurology, rehabilitation, or utilization review. Knowledge of ...

New

The Excalibur Group

Registered Nurse I

Washington, DC · On-site

Registered Nurse I Location: Washington, DC About the Role: The Registered Nurse I provides ... Clinical experience in orthopedics, neurology, rehabilitation, or utilization review. Knowledge of ...

New

August Iliff

MDS Coordinator (RN)

Dunn Loring, VA · On-site

$37.25 - $45.25/hr

... utilization review meetings • Ensure timely completion, validation, and transmission of all MDS assessments • Collaborate with therapy, nursing, and interdisciplinary team members on ARDs and ...

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All JobsUtilization Review Nurse JobsUtilization Review Nurse Jobs in Reston, VA

Utilization Review Nurse information

See Reston, VA salary details

$22

$43

$71

How much do utilization review nurse jobs pay per hour?

As of Sep 4, 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?

AspectUtilization Review NurseCase Manager
CredentialsRN license, certification in utilization review (e.g., URAC)RN license, case management certification (e.g., CCM)
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, insurance companies, community health settings
Employer & Industry UsagePrimarily in insurance and healthcare organizations for reviewing medical necessityIn 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:

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

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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:

Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in Reston, VA as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 17% Part Time, 2% Contract, and 1% Nights. Highlights an 85% Physical, 4% Hybrid, and 11% Remote job distribution, with an average salary of $91,496 per year, or $44 per hour.

Travel Nurse RN - Case Manager, Utilization Review - $2,150 per week

AMN Healthcare Revenue Cycle

Woodbridge, VA • On-site

$2.1K/wk

Other

Medical, Dental, Vision, Life, Retirement

This job post has expired 2 days ago. Applications are no longer accepted.

Job description

AMN Healthcare Revenue Cycle is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Woodbridge, Virginia.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Start Date: ASAP
  • Duration: 13 weeks
  • 36 hours per week
  • Shift: 12 hours
  • Employment Type: Travel

Job Description & Requirements
RN CM
StartDate: 8/24/2026 Pay Rate: $1800.00 - $2500.00
POSITION SUMMARY 2 RN CM
POSITION DUTIES DCP
MINIMUM REQUIRED QUALIFICATIONS MSW; 2+ years minimum of acute care hospital experience
PREFERRED QUALIFICATIONS Experienced traveler with lots of LOS expereince
LENGTH OF ASSIGNMENT 13 weeks
SHIFT / HOURS PER WEEK 8:30-5:00 Monday - Friday
SYSTEMS EPIC
START DATE ASAP
Job Benefits
Becoming an AMN Healthcare professional gives you the incredible opportunity to gain critical career experience, work with new people, and earn a highly competitive salary—but the perks don't stop there. There are many additional benefits to enjoy, including:

  • Medical, dental and vision benefits
  • Earned time off and paid holidays
  • Paid continuing education time
  • 401(K) retirement planning
  • Short-term disability, life insurance, paid jury duty
  • Access to the largest network of facilities and providers in the country
  • Industry experienced workforce management team
  • Licensure and certification reimbursement

About the Company
At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable.

AMN Healthcare Revenue Cycle Job ID #3559616. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN CM

About AMN Healthcare Revenue Cycle

AMN Healthcare is a leading force in the healthcare industry, committed to being the most trusted, innovative, and influential partner for healthcare organizations. With a focus on providing quality patient care, AMN Healthcare offers holistic solutions that reduce costs, streamline processes, and improve efficiencies. The company boasts over 30 years of experience and takes pride in staffing leading healthcare facilities with the nation's best travelers. As an industry leader, AMN Healthcare offers a diverse team dedicated to supporting healthcare workers and facilities, ensuring a personalized and supportive experience for both clients and candidates.

Why Vivian Health?

Be sure to apply via Vivian Health to increase your chances of landing your perfect job. Just complete your Vivian Health profileonce, and get access to thousands of opportunities across the country. Then keep up to date with your job application process and conversations with our easy to use app.

Benefits
  • Medical benefits
  • Dental benefits
  • Company provided housing options
  • Continuing Education

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