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Utilization Reviewer Jobs in Reston, VA (NOW HIRING)

Trinity Health

Physician Advisor

Silver Spring, MD · On-site

$98.65 - $147.98/hr

Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR) LOC and clinical documentation. 5. Revenue Excellence: conduct verbal and written Peer to Peer ...

Trinityhealth

Physician Advisor

Silver Spring, MD

$98.65 - $147.98/hr

Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR) LOC and clinical documentation. 5. Revenue Excellence: conduct verbal and written Peer to Peer ...

Trinity Health

Physician Advisor

Silver Spring, MD · On-site

$98.65 - $147.98/hr

Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR) LOC and clinical documentation. 5. Revenue Excellence: conduct verbal and written Peer to Peer ...

UHS

Director of Social Work

Washington, DC

Monitors insurance requirements and keeps utilization reviewer and other treatment team members current with patient's progress, family meetings, and other case occurrences. * Performs case ...

Trinityhealth

Physican-OB/GYN

Germantown, MD · On-site

$61.25 - $140/hr

Participate in quality, risk, and utilization review processes. * Supervise and teach residents and other learners within the hospital. * Support and promote Holy Cross Hospital's perinatal safety ...

Trinity Health

Physican-OB/GYN

Silver Spring, MD

$61.25 - $140/hr

Participate in quality, risk, and utilization review processes. * Supervise and teach residents and other learners within the hospital. * Support and promote Holy Cross Hospital's perinatal safety ...

Trinityhealth

Physican-OB/GYN

Silver Spring, MD · On-site

$61.25 - $140/hr

Participate in quality, risk, and utilization review processes. * Supervise and teach residents and other learners within the hospital. * Support and promote Holy Cross Hospital's perinatal safety ...

Trinity Health

Physican-OB/GYN

Germantown, MD

$61.25 - $140/hr

Participate in quality, risk, and utilization review processes. * Supervise and teach residents and other learners within the hospital. * Support and promote Holy Cross Hospital's perinatal safety ...

Trinity Health

Physican-OB/GYN

Silver Spring, MD · On-site

$61.25 - $140/hr

Participate in quality, risk, and utilization review processes. * Supervise and teach residents and other learners within the hospital. * Support and promote Holy Cross Hospital's perinatal safety ...

Trinity Health

Physican-OB/GYN

Silver Spring, MD

$61.25 - $140/hr

Participate in quality, risk, and utilization review processes. * Supervise and teach residents and other learners within the hospital. * Support and promote Holy Cross Hospital's perinatal safety ...

Spring Leaf Solutions

Assessor

Washington, DC · On-site

Preferred: experience in community-based behavioral health, intake, utilization review, and tools such as ASAM Criteria, PHQ-9, DLA-20, CAFAS, SBIRT, AUDIT, and CALOCUS/LOCUS. Join a mission-driven ...

Springleaf Solutions

Assessor

Washington, DC · On-site

... utilization review, and tools such as ASAM Criteria, PHQ-9, DLA-20, CAFAS, SBIRT, AUDIT, and CALOCUS/LOCUS. Join a mission-driven team committed to expanding access to high-quality behavioral health ...

Springleaf Solutions

Assessor

Washington, DC

Preferred: experience in community-based behavioral health, intake, utilization review, and tools such as ASAM Criteria, PHQ-9, DLA-20, CAFAS, SBIRT, AUDIT, and CALOCUS/LOCUS. Join a mission-driven ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Reston, VA

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 1, 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?

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.

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:
Utilization Reviewer jobs near you
Director Care Management & Population Health

Director Care Management & Population Health

Johns Hopkins Health System

Bethesda, MD • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 22 days ago

Job description

Suburban Hospital has an opportunity for an experienced Director of Care Management & Population Health. This seasoned healthcare leader oversees comprehensive care coordination operations within a hospital setting and provides strategic direction for care coordination, utilization review, social services, and discharge planning to ensure high-quality, cost-effective patient care.
The role demonstrates strong expertise in care coordination, utilization review, case management, discharge planning, and population health, with in-depth knowledge of hospital policies, regulatory requirements, and the Maryland All-Payer Model. This leader directs evidence-based initiatives to improve quality, reduce costs, and enhance outcomes for targeted patient populations, using data analytics to monitor performance, trends, length of stay, readmissions, and resource utilization. The position partners with Information Systems to implement care coordination technologies, ensures compliance with JCAHO and state and federal regulations, and educates leaders and staff on best practices in case management and population health.
The Director collaborates closely with medical staff and hospital leadership to identify trends, address system-level challenges, and enhance care delivery. This role develops and implements care management programs and clinical pathways that optimize resource utilization and improve patient outcomes. In addition, the Director leads population health strategy across the organization, building strong community partnerships and leveraging interdisciplinary teams to advance population health goals.
Suburban Hospital is a 228-bed, not-for-profit, community-based hospital in Bethesda, Maryland. Suburban Hospital is a member of Johns Hopkins Medicine and has served Montgomery County and the surrounding area for more than 65 years. The designated trauma center for Montgomery County, Suburban Hospital is fully accredited by the Joint Commission and has earned ANCC Magnet Recognition for nursing excellence. At Suburban Hospital, our greatest passion is our staff members' commitment to delivering the best patient- and family-centered care possible.
Qualifications:
  • Bachelor of Science in Nursing, BSN (Required)
  • Master's Degree in Nursing or Healthcare Administration (Preferred)
  • Licensed RN
  • Minimum of 7 years of experience with utilization review, clinical pathways, case management, and disease management
  • 3 years of experience in a management capacity role
  • Requires ability to communicate via documentation, telephone, computer and directly with individuals who possess diverse personalities and levels of professional expertise
  • Requires ability to use various computer applications
  • Requires ability to effectively present information to internal and external groups and audiences
  • Requires ability to read, analyze, and interpret complex regulations and documents, financial and business reports and technical journals
  • Requires proficiency in working with and applying mathematical, statistical and financial concepts

What We Offer:
You can become a part of our diverse healthcare leadership team and enjoy extensive benefits with a variety of opportunities for personal and professional growth. From academic medical centers to local community hospitals, from downtown to the suburbs, Johns Hopkins Medicine has a work environment that will fit your personality and career goals.
Comprehensive benefits including medical, dental, and vision insurance; generous paid time off; life and long-term disability coverage; 403(b) retirement plan with employer match; tuition assistance for employees and dependents; free parking and wellness programs just to name a few.
Salary Range: Minimum 152,161.00/annually - Maximum 196,037.00/annually. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.
The Hospital reserves the right to modify employee schedules as needed.
We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.
Johns Hopkins Health System and its affiliates are an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.

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