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Utilization Reviewer Jobs in Reston, VA (NOW HIRING)

Six months psychiatric utilization review either for hospital or external review organization preferred. * Candidates must meet the company's hiring criteria to include a pre-employment verifications ...

Six months psychiatric utilization review either for hospital or external review organization preferred. * Candidates must meet the company's hiring criteria to include a pre-employment verifications ...

Six months psychiatric utilization review either for hospital or external review organization preferred. * Candidates must meet the company's hiring criteria to include a pre-employment verifications ...

RN Utilization Management

Washington, DC · On-site

$89K - $162K/yr

Responsible for clinical review of acute care services based on Medically Necessity criteria the ... Monitors utilization of all services for fraud and abuse. * Performs pre-authorization and pharmacy ...

RN Utilization Management

Washington, DC · On-site

$89K - $162K/yr

Responsible for clinical review of acute care services based on Medically Necessity criteria the ... Monitors utilization of all services for fraud and abuse. * Performs pre-authorization and pharmacy ...

The Clinical Reviewer position supports utilization management activities by assessing the medical necessity and quality of healthcare services through prospective, concurrent, and retrospective ...

The Clinical Reviewer position supports utilization management activities by assessing the medical necessity and quality of healthcare services through prospective, concurrent, and retrospective ...

Bachelor's Degree from an accredited college or university in a related field. * 1+ years Utilization Management/Utilization Review. * 1+ years Private Duty Nursing OR Home Health experience.

... e., utilization management, case management, health call center, and disease management ... independent review, quality management, accreditation, or a related managed care function.

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Utilization Reviewer information

See Reston, VA salary details

$32.3K

$39.5K

$45.8K

How much do utilization reviewer jobs pay per year?

As of Jun 29, 2026, the average yearly pay for utilization reviewer in Reston, VA is $39,525.00, according to ZipRecruiter salary data. Most workers in this role earn between $35,400.00 and $43,700.00 per year, depending on experience, location, and employer.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How does a Utilization Reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What does a utilization reviewer do?

A utilization reviewer evaluates medical records and treatment plans to determine the necessity and appropriateness of healthcare services. They ensure that services comply with insurance policies and industry standards, often using healthcare management software and adhering to regulatory guidelines. This role supports cost containment and quality assurance in healthcare organizations.

How to become a utilization reviewer?

To become a utilization reviewer, candidates typically need a healthcare-related degree such as nursing, health administration, or a related field. Relevant experience in healthcare or insurance, strong analytical skills, and familiarity with medical coding and documentation are important; some roles may require certification such as the Certified Professional Utilization Review (CPUR).

What jobs pay 2000 a day?

Utilization reviewers typically do not earn $2000 a day; such high daily earnings are more common in specialized roles like senior surgeons, high-level consultants, or certain executive positions. These roles often require advanced certifications, extensive experience, and work in high-paying industries such as healthcare, finance, or law. Most utilization review positions offer salaries that are significantly lower than this daily rate.

What Does a Utilization Reviewer Do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

What job makes $10,000 a month without a degree?

A utilization reviewer typically earns between $4,000 and $8,000 per month, depending on experience and location, and usually requires relevant healthcare or insurance knowledge. Jobs that can pay $10,000 a month without a degree include high-level sales, real estate brokers, or certain skilled trades like commercial pilots or specialized technicians, often requiring certifications or extensive experience. These roles often involve self-employment, commissions, or high-demand skills that compensate well without formal college degrees.

What are the key skills and qualifications needed to thrive as a Utilization Reviewer, and why are they important?

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.
What are popular job titles related to Utilization Reviewer jobs in Reston, VA? For Utilization Reviewer jobs in Reston, VA, the most frequently searched job titles are:
What job categories do people searching Utilization Reviewer jobs in Reston, VA look for? The top searched job categories for Utilization Reviewer jobs in Reston, VA are:
What cities near Reston, VA are hiring for Utilization Reviewer jobs? Cities near Reston, VA with the most Utilization Reviewer job openings:
Infographic showing various Utilization Reviewer job openings in Reston, VA as of June 2026, with employment types broken down into 50% Full Time, 47% Part Time, and 3% Contract. Highlights an 51% Physical, 2% Hybrid, and 47% Remote job distribution, with an average salary of $39,525 per year, or $19 per hour.
Utilization Review Coordinator

Utilization Review Coordinator

UHS

Washington, DC • On-site

$33.60 - $50.40/hr

Per diem

Medical, Dental, Vision, Life, Retirement, PTO

Posted 5 days ago


Universal Health Services rating

6.8

Company rating: 6.8 out of 10

Based on 250 frontline employees who took The Breakroom Quiz

483rd of 877 rated healthcare providers


Job description

Responsibilities
The Psychiatric Institute of Washington is a152-bed facility with inpatient, outpatient and partial hospitalization programs. Excellence in behavioral health programs for children, adolescents and adults has been the mission of The Psychiatric Institute of Washington since it opened nearly 50 years ago. As the first and only free standing psychiatric care facilities in Washington, DC, our team has a reputation for providing innovative treatment and care. We strive for excellence, never losing sight of providing patients with hope - hope that although their stay is relatively brief, they may find their way to a brighter future.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
  • Tracks new admissions or transfers to assigned area and is responsible for knowing and following through with certification requirements from admission through discharge. Serves as liaison to on-site external reviewers.
  • Uses Midas for recording reviews and tracking denials. Adds to Midas databases as needed.
  • Teaches staff to document medical necessity through in-services or individual meetings. Monitors quality of records and notifies staff and program director of problems. Available to program director to develop plan for improvement as needed.
  • Supports and guides treatment planning as needed. Continues to bring to staff awareness the need for documentation to flow from and correlate with treatment plan.
  • Informs department director of changes in managed care companies. Maintains awareness of unique status to propose out of plan benefits or to open the door to increase hospital's opportunity to provide services to a larger group.
  • Works appropriately and professionally with all staff and demonstrates a supportive attitude toward the goals of the hospital. Makes recommendations for the hospital based on identified trends.
  • Arranges schedule in consideration of needs of the department, participates in arranging coverage for planned absences and demonstrates a supportive attitude toward the goals of the department.
  • Performs other job related duties as assigned.
Benefit Highlights:
Our employees are our most valuable asset and we are dedicated to provide a challenging and rewarding work environment to all our employees.
  • Generous Paid Time Off
  • Excellent Medical, Dental, Vision and Prescription Drug Plans
  • 401(K) with company match and discounted stock plan
  • UHS employee discounted stock option plan
  • Tuition Reimbursement and Student Loan Repay Program
  • Employee Assistant Program (EAP)
  • Life Insurance and Disability Insurances
  • Flexible Spending Account
  • Pre-tax Metro SmartTrip Benefits
  • Career development opportunities within UHS and its 300+ Subsidiaries!

Who we are:
One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $11.6 billion in 2020. In 2021, UHS was again recognized as one of the World's Most Admired Companies by Fortune; in 2020, ranked #281 on the Fortune 500; and listed #330 in Forbes ranking of U.S.' Largest Public Companies. Headquartered in King of Prussia, PA, UHS has 89,000 employees and through its subsidiaries operates 26 acute care hospitals, 334 behavioral health facilities, 39 outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 38 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom.
Qualifications
  • Bachelor's degree in applicable field of study required
  • Six months psychiatric utilization review either for hospital or external review organization preferred.
  • Candidates must meet the company's hiring criteria to include a pre-employment verifications, background investigation and drug test.
COVID Requirements
PIW requires its staff to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, or religious belief that prevents them from being vaccinated.
E-VERIFY Statement
PIW participates in E-Verify. We will provide the Social Security Administration, and if necessary, the Department of Homeland Security, with information from each new employee's Form I-9 to confirm work authorization. Please note that we do not use this information to pre-screen job applicants.
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Notice
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852- 3449.

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About Universal Health Services

Sourced by ZipRecruiter

Universal Health Services (UHS) is a major player in the healthcare industry, based in King of Prussia, Pennsylvania, U.S. Founded in 1978, UHS offers hospital and healthcare services. Their diverse services range from acute care hospitals, behavioral health facilities and ambulatory centers nationwide. The company's mission of enhancing the health and well-being of their patients is reflected in their commitment to 'Helping Individuals Live Longer, Healthier and Happier Lives'. Universal Health Services' consistent growth and success in their industry have been recognized on numerous occasions, including being ranked amongst the Fortune 500 list of largest companies.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

King of Prussia, PA, US