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Utilization Review Rn Jobs in Washington, DC (NOW HIRING)

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 ...

AmeriHealth Caritas

Clinical Care Reviewer UM

Washington, DC · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Experience conducting utilization management reviews specific to a Medicare population across multiple states for a payer preferred Licensure * An active and unencumbered Registered Nurse (RN) ...

Amerihealth Caritas

Clinical Care Reviewer UM

Washington, DC · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Experience conducting utilization management reviews specific to a Medicare population across multiple states for a payer preferred Licensure * An active and unencumbered Registered Nurse (RN) ...

LifeHealth

Medical Review RN

Washington, DC

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 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 ...

Luminis Health

Utilization Management Nurse

Annapolis, MD

$34 - $55/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Reviews the medical record by applying utilization review criteria, to assess clinical, financial ... Current RN license from Maryland Board of Nursing. Working Conditions, Equipment, Physical Demands:

Luminis Health

Utilization Management Nurse

Lanham, MD

$34 - $55/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Reviews the medical record by applying utilization review criteria, to assess clinical, financial ... Current RN license from Maryland Board of Nursing. Working Conditions, Equipment, Physical Demands:

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Showing results 21-40

All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Washington, DC

Utilization Review Rn information

See Washington, DC salary details

$24

$47

$78

How much do utilization review rn jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for utilization review rn in Washington, DC is $47.87, according to ZipRecruiter salary data. Most workers in this role earn between $37.84 and $55.00 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 Washington, DC?

The most popular types of Utilization Review Rn jobs in Washington, DC are:

What are popular job titles related to Utilization Review Rn jobs in Washington, DC?

For Utilization Review Rn jobs in Washington, DC, the most frequently searched job titles are:

What job categories do people searching Utilization Review Rn jobs in Washington, DC look for?

The top searched job categories for Utilization Review Rn jobs in Washington, DC are:

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Washington, DC as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $99,571 per year, or $47.9 per hour.

Registered Nurse - Utilization Management

Spectrum Healthcare Resources

Camp Springs, MD

Full-time

Posted 22 days ago

Job description

Job Description

Spectrum Healthcare Resources has an opportunity for a Registered Nurse Utilization Management (UMRN) working at Joint Base Andrews in Washington, D.C. 

Requirements:

  • Associates Degree of Nursing
  • Current, full, active, and unrestricted license to practice as a Registered Nurse (Any State)
  • Must have at least 36 months of total nursing experience in direct patient care clinical setting. Must have utilization management, utilization review or case management experience for 24 recent consecutive months
  • Certified/certification eligible in relevant specialty, such as Certified Managed Care Nurse through the American Board of Managed Care Nurses, or Certified Informatics Nursing, Ambulatory Care Nursing, Medical-Surgical Nursing, or Nursing Case Management through the American Nurses Credentialing Center.
  •  
  • Highly organized, self-directed worker able to function in a high-volume environment without distractions.
  • Strong verbal and written communication skills.
  • Proficient level of experience with Microsoft Office applications and strong technical aptitude.

Work Schedule:

  • Monday - Friday
  • No nights and weekends
  • 8 hours a day

Company Overview:

Spectrum Healthcare Resources (SHR) was established in 1988 to deliver systems and processes designed to meet the unique needs of Military and VA Health Systems.  SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies through various contracting vehicles.  A Joint Commission Health Care Staffing Services firm, SHR is the military staffing division of TeamHealth, a Nationwide organization that serves 850 civilian and military hospitals with a team of 9,600 affiliated health care professionals.

EOE/Disabled/Veterans

Joseph Day

Recruiter

Direct: (314) 744-4138

424 S Woods Mill Rd | Suite 205 | Town & Country, MO 63017

Location : LocationUS-MD-Camp SpringsRecruiter : Full Name: First LastJoseph DayDirect phone number314-744-4138Recruiter : Emailjoseph_day@spectrumhealth.comEmployment Type: OTHER
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About Spectrum Healthcare Resources

Sourced by ZipRecruiter

Spectrum is a leading organization that provides program management and physician and clinical staffing services to United States Military Treatment Facilities, VA Clinics and Federal Agencies. We are dedicated to the markets we serve, leading our organization’s experience for almost three decades.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Saint Louis, MO, US

Year founded

1988

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