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

Amivie, LLC

Registered Nurse (CB HomeCare)

Springfield, VA · On-site

$75 - $95/hr

Participate on an assigned advisory board or utilization review committee. * Review all client ... Maintain current RN license and required continuing education. * Obtain annual TB testing/screening ...

Hscsnhealthplan

HSCSN RN Care Manager

Washington, DC · On-site

$77.58 - $129.29/hr

... Utilization Review, Disease Management or Managed Care (Required) 1 year Working in a Public ... Registered Nurse DC License Upon Hire (Required) Certified Case Manager (CCM) 1 Year (Preferred)

Erickson

Clinical Manager, RN

Ashburn, VA · On-site

... 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

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

Utilization Review Rn information

See Washington, DC salary details

$24

$48

$78

How much do utilization review rn jobs pay per hour?

As of Sep 4, 2026, the average hourly pay for utilization review rn in Washington, DC is $48.10, according to ZipRecruiter salary data. Most workers in this role earn between $38.03 and $55.24 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 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, 73% Full Time, 23% Part Time, 2% Contract, and 1% Nights. Highlights an 84% Physical, 2% Hybrid, and 14% Remote job distribution, with an average salary of $99,674 per year, or $47.9 per hour.

Registered Nurse (RN) Outpatient Behavioral Health

Inova Health System

Sterling, VA • On-site

$60 - $80/hr

Other

Medical, Dental, Vision

Re-posted 2 days ago

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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