A recognized healthcare provider is seeking a Board Certified Orthopaedic Spine Surgeon to conduct utilization reviews. This telework position allows for a flexible schedule within a standard Monday ...
A recognized healthcare provider is seeking a Board Certified Orthopaedic Spine Surgeon to conduct utilization reviews. This telework position allows for a flexible schedule within a standard Monday ...
Organizes utilization management caseload based on daily volume, and complexity of individual case management processes. * Performs review within designated timeframe after receiving initial ...
Organizes utilization management caseload based on daily volume, and complexity of individual case management processes. * Performs review within designated timeframe after receiving initial ...
RN Utilization Mgmt
Washington, DC · On-site
$89.07K - $162.80K/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 Mgmt
Washington, DC · On-site
$89.07K - $162.80K/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 ...
Additional Information All your information will be kept confidential according to EEO guidelines.
Additional Information All your information will be kept confidential according to EEO guidelines.
Additional Information All your information will be kept confidential according to EEO guidelines.
Additional Information All your information will be kept confidential according to EEO guidelines.
The Utilization Review Advisor (Advisor) position conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer to peers, writing ...
The Utilization Review Advisor (Advisor) position conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer to peers, writing ...
RN Utilization Management
Washington, DC · On-site
$89.07K - $162.80K/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
$89.07K - $162.80K/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 Utilization Review Advisor (Advisor) position conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer to peers, writing ...
The Utilization Review Advisor (Advisor) position conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer to peers, writing ...
Additional Information All your information will be kept confidential according to EEO guidelines.
Additional Information All your information will be kept confidential according to EEO guidelines.
A national provider of utilization review services seeks independent contract reviewers for a telework opportunity. Physicians can customize their caseload and schedule while providing advisory-only ...
A national provider of utilization review services seeks independent contract reviewers for a telework opportunity. Physicians can customize their caseload and schedule while providing advisory-only ...
A national Utilization Review provider is seeking Board Certified physicians with an active New York license for a telework opportunity. This role allows for flexible scheduling, where physicians can ...
A national Utilization Review provider is seeking Board Certified physicians with an active New York license for a telework opportunity. This role allows for flexible scheduling, where physicians can ...
Referral Management (Non-Nurse) Reviewer
Bethesda, MD · On-site
$23.56/hr
At least 2 years of experience in Utilization Management, Referral Management, Authorization ... Review and process referrals for administrative and clinical completeness and appropriateness ...
Referral Management (Non-Nurse) Reviewer
Bethesda, MD · On-site
$23.56/hr
At least 2 years of experience in Utilization Management, Referral Management, Authorization ... Review and process referrals for administrative and clinical completeness and appropriateness ...
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertiseExpanded credentials as an expert in Independent Medical Exams and ...
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertiseExpanded credentials as an expert in Independent Medical Exams and ...
FSM Utilization Specialist
Washington, DC · On-site
Conduct periodic reconciliation reviews of external interfaces with various field offices in order ... Utilization Specialist shall have consecutive employment in a position with comparable ...
FSM Utilization Specialist
Washington, DC · On-site
Conduct periodic reconciliation reviews of external interfaces with various field offices in order ... Utilization Specialist shall have consecutive employment in a position with comparable ...
Board Certified Gastroenterology Physician Advisor - Disability Peer Reviewer
Washington, DC · Remote
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertiseExpanded credentials as an expert in Independent Medical Exams and ...
Board Certified Gastroenterology Physician Advisor - Disability Peer Reviewer
Washington, DC · Remote
Enhanced industry expertise, strengthening your medical practice with medical necessity and utilization review/management expertiseExpanded credentials as an expert in Independent Medical Exams and ...
PRN Clinical Reviewer - Substance Use (LPCC, LMFT, LICSW)
Mclean, VA · Remote
$28.37 - $39.19/hr
... of Utilization Review (UR) or Utilization Management (UM) or Prior Authorization experience. In-depth understanding of ASAM criteria and its practical application in clinical environments.
PRN Clinical Reviewer - Substance Use (LPCC, LMFT, LICSW)
Mclean, VA · Remote
$28.37 - $39.19/hr
... of Utilization Review (UR) or Utilization Management (UM) or Prior Authorization experience. In-depth understanding of ASAM criteria and its practical application in clinical environments.
Director of Case Management
Dulles, VA · On-site
$120K - $130K/yr
Oversee utilization review and discharge planning processes * Ensure compliance with regulatory and accreditation standards * Partner with interdisciplinary teams to optimize patient outcomes and ...
Quick apply
Director of Case Management
Dulles, VA · On-site
$120K - $130K/yr
Oversee utilization review and discharge planning processes * Ensure compliance with regulatory and accreditation standards * Partner with interdisciplinary teams to optimize patient outcomes and ...
Director of Case Management
$120K - $130K/yr
Oversee utilization review and discharge planning processes * Ensure compliance with regulatory and accreditation standards * Partner with interdisciplinary teams to optimize patient outcomes and ...
Quick apply
Director of Case Management
$120K - $130K/yr
Oversee utilization review and discharge planning processes * Ensure compliance with regulatory and accreditation standards * Partner with interdisciplinary teams to optimize patient outcomes and ...
Utilization Review & Authorizations * Oversee authorization strategy and utilization review processes across all levels of care. * Ensure timely and accurate submission of clinical documentation ...
Utilization Review & Authorizations * Oversee authorization strategy and utilization review processes across all levels of care. * Ensure timely and accurate submission of clinical documentation ...
Utilization Review & Authorizations * Oversee authorization strategy and utilization review processes across all levels of care. * Ensure timely and accurate submission of clinical documentation ...
Utilization Review & Authorizations * Oversee authorization strategy and utilization review processes across all levels of care. * Ensure timely and accurate submission of clinical documentation ...
Utilization Reviewer information
See Reston, VA salary details
$32.3K - $33.5K
3% of jobs
$33.5K - $34.7K
14% of jobs
$35.6K is the 25th percentile. Wages below this are outliers.
$34.7K - $35.9K
12% of jobs
$35.9K - $37.2K
12% of jobs
$37.2K - $38.4K
9% of jobs
The median wage is $38.5K / yr.
$38.4K - $39.6K
5% of jobs
$39.6K - $40.9K
0% of jobs
$40.9K - $42.1K
3% of jobs
$42.1K - $43.3K
9% of jobs
$43.8K is the 75th percentile. Wages above this are outliers.
$43.3K - $44.5K
20% of jobs
$44.5K - $45.8K
13% of jobs
$32.3K
$39.5K
$45.8K
How much do utilization reviewer jobs pay per year?
As of May 30, 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 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 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.
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 jobs make $3,000 a month without a degree?
Utilization reviewers typically earn between $3,000 and $4,500 per month, depending on experience and location, and often do not require a degree. Many related roles in healthcare or insurance involve reviewing claims or data, with some positions offering on-the-job training and certifications. Other jobs that can pay around $3,000 monthly without a degree include administrative assistants, sales representatives, and certain skilled trades, though wages vary by region and industry standards.
What is the difference between Utilization Reviewer vs Medical Coder?
| Aspect | Utilization Reviewer | Medical Coder |
|---|---|---|
| Required Credentials | Typically requires healthcare-related certifications, such as RHIT, RHIA, or CPC | Usually requires coding certifications like CPC, CCS, or CCS-P |
| Work Environment | Healthcare facilities, insurance companies, or utilization review organizations | Hospitals, clinics, or medical billing companies |
| Employer & Industry Usage | Used in insurance, managed care, and healthcare administration | Used 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.
More about Utilization Reviewer jobs
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:
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Job description
A recognized healthcare provider is seeking a Board Certified Orthopaedic Spine Surgeon to conduct utilization reviews. This telework position allows for a flexible schedule within a standard Monday – Friday work week. Responsibilities include reviewing medical records, ensuring compliance with state regulations, and providing clear rationale for case decisions.
Preferred candidates should have a license in specific states. Compensation is based on a per-case basis as a 1099 independent contractor. #J-18808-Ljbffr
About Dane Street
Sourced by ZipRecruiter
Company size
51 - 200 Employees
Headquarters location
Boston, MA, US
Year founded
2008