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Utilization Review Rn Jobs in Arlington, VA (NOW HIRING)

MedStar Health

RN Utilization Review

Clinton, MD · On-site

$89K - $162K/yr

Must be local to the DC/MD region with acute Utilization Review RN experience** General Summary of Position Conducts admission concurrent and retrospective case reviews to ensure appropriate admit ...

MedStar Health

RN Utilization Review

Clinton, MD · On-site

$89K - $162K/yr

Must be local to the DC/MD region with acute Utilization Review RN experience** General Summary of Position Conducts admission concurrent and retrospective case reviews to ensure appropriate admit ...

MedStar Health

RN Team Lead Utilization Review

Clinton, MD · On-site

$89K - $162K/yr

About the Job Candidate must have acute care Utilization Review experience. Candidate must live in ... - Registered Nurse - State Licensure and/or Compact State Licensure the District of Columbia or ...

LifeHealth

Medical Review RN

Washington, DC · On-site

Medical Review RN * Date: Start Date - TBD * Shift Time: 0800-1630 M-F * Location: Washington, DC Position Summary: LifeHealth Medical Review Nurse (MRN) is responsible for the initial chart review ...

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All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Arlington, VA

Utilization Review Rn information

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$24

$48

$79

How much do utilization review rn jobs pay per hour?

As of Aug 3, 2026, the average hourly pay for utilization review rn in Arlington, VA is $48.62, according to ZipRecruiter salary data. Most workers in this role earn between $38.41 and $55.82 per hour, depending on experience, location, and employer.

How does a utilization review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

What are the key skills and qualifications needed to thrive as a utilization review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

How to get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or knowledge of medical coding and insurance processes can enhance your qualifications. Gaining experience in case management or health insurance companies can also improve your chances of entering the field.

What is the difference between Utilization Review Rn vs Case Manager?

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

What is a utilization review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.
What are the most commonly searched types of Utilization Review Rn jobs in Arlington, VA? The most popular types of Utilization Review Rn jobs in Arlington, VA are:
What are popular job titles related to Utilization Review Rn jobs in Arlington, VA? For Utilization Review Rn jobs in Arlington, VA, the most frequently searched job titles are:
What job categories do people searching Utilization Review Rn jobs in Arlington, VA look for? The top searched job categories for Utilization Review Rn jobs in Arlington, VA are:
What cities near Arlington, VA are hiring for Utilization Review Rn jobs? Cities near Arlington, VA with the most Utilization Review Rn job openings:
Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Arlington, VA as of July 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $101,125 per year, or $48.6 per hour.

RN Utilization Review

MedStar Health

Clinton, MD • On-site

$89K - $162K/yr

Per diem

Posted 6 days ago

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 239 frontline employees who took The Breakroom Quiz

132nd of 887 rated healthcare providers

Job description

About the Job
**Must be local to the DC/MD region with acute Utilization Review RN experience**
General Summary of Position
Conducts admission concurrent and retrospective case reviews to ensure appropriate admit status and level of care by utilizing the nationally approved guidelines. Collaborates with medical staff and ancillary hospital disciplines to ensure high-quality patient care in the most efficient way.
Primary Duties and Responsibilities
  • Conducts admission concurrent and retrospective case reviews to meet hospital objectives of high-quality patient care in the most efficient way.
  • Strives to meet the department goals adheres to organizational policies procedures and quality standards. Complies with rules and regulations set forth by the governmental and accrediting agencies.
  • Collaborates with medical staff physician advisor social workers and other ancillary hospital disciplines to meet patients' health care needs in the most cost-effective way.
  • Performs patients' medical record reviews document pertinent information and communicate with third party payors in a timely fashion to ensure proper hospital reimbursement and eliminate unnecessary denials.
  • Implements strategies to avoid potential denials by communicating with all the key stakeholders including attending physician.
  • If necessary non-coverage ABN MOON letters and other appropriate documents as per organizational governmental and accrediting organizations policies and regulations.
  • Actively participates in IDRs Length of Stay and other meetings as per hospital policies.
  • Identifies potential risks pertaining to patients' care and communicates with appropriate hospital discipline including risk management quality safety and infection control.
  • Serves as a resource to the health care team by educating the health care team through in-services staff meetings and formal educational settings in areas of utilization management.
  • Demonstrate current knowledge of State and Federal regulatory requirements as it pertains to the utilization review process.
  • Identifies dynamics of neglect/abuse and reports to the appropriate in-house departments and governmental agencies.

Minimal Qualifications
Education
  • Associate's degree in Nursing required
  • Bachelor's degree in Nursing preferred

Experience
  • 3-4 years Experience in the acute clinical care setting required
  • 2 years Case Management insurance UR or related experience preferred

Licenses and Certifications
  • RN - Registered Nurse - State Licensure and/or Compact State Licensure in the State of Maryland required
  • CCM - Certified Case Manager preferred

Knowledge Skills and Abilities
  • Excellent problem-solving skills and ability to exercise independent judgment.
  • Business acumen and leadership skills.
  • Strong verbal and written communication skills with ability to effectively interact with all levels of management internal departments and external agencies.
  • Working knowledge of various computer software applications.

This position has a hiring range of
USD $89,065.00 - USD $162,801.00 /Yr.

What Medstar Health employees say

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About Medstar Health

Sourced by ZipRecruiter

MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Columbia, MD, US

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