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

657 Ashby Ponds, Inc.

Clinical Manager, RN

Ashburn, VA · On-site

$105 - $120/hr

... Utilization Review, and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... Current Registered Nurse license for the state in which they operate. * Current CPR required

New

Trinityhealth

Physican-OB/GYN

Germantown, MD · On-site

$61.25 - $140/hr

... nurse practitioners, physician assistants, and other healthcare providers to deliver comprehensive care. * Participate in quality, risk, and utilization review processes. * Supervise and teach ...

Erickson

Clinical Manager, RN

Ashburn, VA

... Utilization Review, and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... Current Registered Nurse license for the state in which they operate. * Current CPR required

Trinity Health

Physican-OB/GYN

Germantown, MD · On-site

$61.25 - $140/hr

... nurse practitioners, physician assistants, and other healthcare providers to deliver comprehensive care. * Participate in quality, risk, and utilization review processes. * Supervise and teach ...

Trinity Health

Physican-OB/GYN

Silver Spring, MD · On-site

$61.25 - $140/hr

... nurse practitioners, physician assistants, and other healthcare providers to deliver comprehensive care. * Participate in quality, risk, and utilization review processes. * Supervise and teach ...

Trinityhealth

Physican-OB/GYN

Silver Spring, MD · On-site

$61.25 - $140/hr

... nurse practitioners, physician assistants, and other healthcare providers to deliver comprehensive care. * Participate in quality, risk, and utilization review processes. * Supervise and teach ...

Trinity Health

Physican-OB/GYN

Silver Spring, MD · On-site

$61.25 - $140/hr

... nurse practitioners, physician assistants, and other healthcare providers to deliver comprehensive care. * Participate in quality, risk, and utilization review processes. * Supervise and teach ...

Discovery Behavioral Health

Nurse Administrator

Mclean, VA · On-site

$85K - $100K/yr

Participates in the utilization review process and communicates with the nursing team on related patient authorizations. * Audits and ensures the med rooms are compliant with regulatory requirements.

Hscsnhealthplan

HSCSN RN Care Manager

Washington, DC · On-site

$77.58 - $129.29/hr

## HSCSN RN Care ManagerApplylocations: HSCSN Wellness Centertime type: Full timeposted on: Posted 25 ... Utilization Review, Disease Management or Managed Care (Required) 1 year Working in a Public ...

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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 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?

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

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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.

Registered Nurse (RN) Outpatient Behavioral Health

Inova Health System

Sterling, VA • On-site

$60 - $80/hr

Other

Medical, Dental, Vision

Re-posted yesterday

Inova Health System rating

7.5

Company rating: 7.5 out of 10

Based on 261 frontline employees who took The Breakroom Quiz

232nd of 898 rated healthcare providers

Job description

Inova Behavioral Health Services is looking for a dedicated Registered Nurse to join the team at their Sterling location. This role will be full-time day shift from Monday - Friday. Our nurses work five 8-hour shifts and have the choice to work 8:00 am to 4:30 pm. No weekends, no holidays, no call.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:
  • Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
  • Retirement: Inova matches the first 5% of eligible contributions - starting on your first day.
  • Tuition and Student Loan Assistance: offeringup to $5,250 per year in education assistance and up to $10,000 for student loans.
  • Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
  • Work/Life Balance: offeringpaid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities on select positions.

The Registered Nurse Outpatient provides safe/therapeutic care in a holistic and systematic way in a physician practice or other outpatient setting. Incorporates differences into the provision of care while integrating knowledge, skills and experiences to meet the needs of patients and families to include patient and family education. Achieves desired patient outcomes by using an integrated approach. Incorporates data and information to improve care and enhances outcomes while ensuring improvements in practice settings. Provides direction and guidance to others regarding practice while serving as a resource, preceptor and mentor.

Minimum Qualifications:
  • Education: BSN or ADN - If ADN then complete BSN within 5 years of start date
  • BLS for Healthcare Provider Certification from the American Heart Association required
  • RN licensed, and eligible to practice in the Commonwealth of Virginia.
  • Proficient in English, strong verbal and written communication skills. Exceptional interpersonal skill and the ability to display a caring demeanor towards others. Proficient computer skills required.
Preferred Qualifications:
  • Previous Behavioral Health experience strongly preferred,
  • Case management or utilization review preferred
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