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Utilization Review Nurse Jobs in Springfield, VA

Amerihealth Caritas

UM 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 ...

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

Utilization Review Nurse information

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$22

$44

$72

How much do utilization review nurse jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for utilization review nurse in Springfield, VA is $44.16, according to ZipRecruiter salary data. Most workers in this role earn between $34.90 and $50.72 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 Springfield, VA?

The most popular types of Utilization Review Nurse jobs in Springfield, VA are:

What are popular job titles related to Utilization Review Nurse jobs in Springfield, VA?

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

What cities near Springfield, VA are hiring for Utilization Review Nurse jobs?

Cities near Springfield, VA with the most Utilization Review Nurse job openings:

Utilization Review Nurse jobs near you
Infographic showing various Utilization Review Nurse job openings in Springfield, VA as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 18% Part Time, 1% Temporary, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $91,862 per year, or $44.2 per hour.

UTILIZATION REVIEW NURSE THP

Korak Healthsource Group

Washington, DC • On-site

Full-time

Re-posted 16 days ago

Job description

Additional Information

All your information will be kept confidential according to EEO guidelines.

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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

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