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

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 LLC

Medical Review RN

Washington, DC · On-site

$45/hr

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 ...

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 Sep 4, 2026, the average hourly pay for utilization review rn in Arlington, VA is $48.72, according to ZipRecruiter salary data. Most workers in this role earn between $38.51 and $55.96 per hour, depending on experience, location, and employer.

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.

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.

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.

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 case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

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 August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, 2% Contract, and 1% Nights. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $101,125 per year, or $48.6 per hour.

RN Reviewer/ Workers' Compensation Utilization Review - REMOTE

MICHIGAN PEER REVIEW ORGANIZATION

Washington, DC • Remote

Contractor

Posted 2 days ago

New

Job description

iMPROve Health is seeking an RN Reviewer (Workers' Compensation Utilization Review) to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis.  As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type.

BENEFITS:

  • Make a Difference: Use your clinical knowledge to improve the quality of care patients receive.
  • Professional Recognition: Join a network of highly respected experts in your specialty.
  • Competitive Compensation: Receive fair pay for your time and expertise.
  • Protect Standards of Care: Help uphold the integrity of your profession.
  • Work Remotely: Review cases from the convenience of your home or office.
Qualifications

  • Active, unrestricted RN license required; 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' Compensation Medical Treatment Guidelines and evidence-based clinical criteria.
  • Strong clinical assessment, critical thinking, and written communication skills.
  • Experience reviewing medical records and determining medical necessity preferred.

Responsibilities

  • Review treatment requests and medical records for medical necessity and guideline compliance.
  • Apply Workers' Compensation Medical Treatment Guidelines and applicable regulatory requirements.
  • Prepare clear, objective, and timely review determinations.
  • Maintain confidentiality and comply with HIPAA and other applicable privacy requirements.

Technical Requirements

  • Reliable high-speed internet/Wi-Fi connection.
  • Secure home office environment with the ability to protect confidential information.
  • Proficiency using web-based review platforms and Microsoft Office applications.

OTHER REQUIREMENTS:

  • Must complete the electronic credentialing application and receive organizational approval prior to performing a case review.
  • Must complete a conflict of interest attestation upon credentialing and prior to performing a case review.
  • Active hospital medical staff privileges may be required, as applicable.
  • Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status.

EOE/VET/Disability