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Utilization Reviewer Jobs in Reston, VA (NOW HIRING)

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 ...

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 ...

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 ...

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 ...

Leads all utilization review, social work and discharge planning activities within assigned operating unit. * Oversees the day to day operation of all Case Management related activities to include ...

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Showing results 1-20

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.
FSM Utilization Specialist

Contractor

Medical, Dental, Vision, Retirement, PTO

Posted 23 days ago


Job description

Company Description

ProSidian is a Management and Operations Consulting Services Firm focusing on providing value to clients through tailored solutions based on industry leading practices.  ProSidian services focus on the broad spectrum of Risk Management, Compliance, Business Process, IT Effectiveness, Energy & Sustainability, and Talent Management.  We help forward thinking clients solve problems and improve operations. 
Launched by former Big 4 Management Consultants; our multidisciplinary teams bring together the talents of nearly 190 professionals nationally to complete a wide variety of engagements for Private Companies, Fortune 1,000 Enterprises, and Government Agencies of all sizes.  Our Services are deployed across the enterprise, target drivers of economic profit (growth, margin and efficiency), and are aligned at the intersections of assets, processes, policies and people delivering value. 
ProSidian clients represent a broad spectrum of industries to include but are not limited to Energy, Manufacturing, Chemical, Retail, Healthcare, Telecommunications, Hospitality, Pharmaceuticals, Banking & Financial Services, Transportation, Federal and State Government Agencies.  Learn More About ProSidian Consulting at www.ProSidian.com.

Job Description

ProSidian Seeks a FSM (Financial Service Management) Utilization Specialist to support an engagement for an American scientific agency within the United States Department of Commerce that focuses on the conditions of the oceans, major waterways, and the atmosphere.  Dedicated to the understanding and stewardship of the environment, the Agency's mission is to understand and predict changes in climate, weather, oceans, and coasts, to share that knowledge and information with others, and to conserve and manage coastal and marine ecosystems and resources. 

The ProSidian Engagement Team Members work to provide multi-functional Enterprise Services Staff Support Services with functional areas to support Department Offices in information technology, financial management, human resources, program management and administrative support.  The staff augmentation is required to support a myriad of standard services required across the Department that include skill sets in information technology, financial management, human resources, program management, economic analysis, executive support and administrative support.

FSM Utilization Specialist Candidates shall work to support requirements for Program Support and The Utilization Specialist Performs the execution of the chargeback activities for an organization. Monitors cost of services. Ensures compliance with the terms and conditions of the chargeback agreement between the organization and the customers. Documents financial issues affecting provider delivery of services. Documents and validates changes and amendments of the fee structure. Recommends chargeback methodologies by service and works with leadership to proactively monitor and make recommendations for improvements in cost tracking, reporting, and execution. Serves as the team leader for chargeback rate development, rate analysis, and rate modeling. Personally leads the chargeback rate structure development, analysis, and modeling programs, for assigned areas of responsibility. Independently organizes and directs complete chargeback studies, providing for background investigation, data collection and reduction, derivation or identification of established analytical costing and computational techniques, analysis calculations and preparation of final report. Forecast fluctuations in future demand and predict future service consumption based on past services delivered and consumed.  Requires BS/BA in appropriate field (or equivalent) and approximately 4 years chargeback, utilization, and activity based costing experience.

  • Have a strong understanding of federal government business operations and work process.
  • Support project teams and program managers and provide daily execution assigned work functions.
  • Provide management support to collect, evaluate and test financial data for a number of recurring departmental processes and reviews. Must summarize issues and findings in a clear and logical manner.
  • Have strong analytical and problem solving skills.
  • Conduct periodic reconciliation reviews of external interfaces with various field offices in order to identify and correct data gaps, financial discrepancies and errors.
  • Work with a variety of IT systems to provide multi-functional Enterprise Services Staff Support Services on behalf of Enterprise Services
  • Provide acquisition support for all bureaus with functional areas include skill sets in information technology, financial management, human resources, program management, economic analysis, executive support and administrative support.
  • Have advanced experience with Microsoft Office Word, PowerPoint, Excel, and Outlook.
  • Must have strong presentation skills and be able to communicate effectively orally and in writing to support a myriad of standard services required across the Department
Qualifications

The FSM Utilization Specialist shall have consecutive employment in a position with comparable responsibilities within the past five (5) years, Must be able to use a computer to communicate via email; and proficient in Microsoft Office Products (Word/Excel/Power point) and related tools and technology required for the position.  Work products shall be thorough, accurate, appropriately documented, and comply with established criteria. The candidate shall ensure that duties are performed in a competent and professional manner that meets milestones/delivery schedules as outlined.

A bachelor's degree is required with at least three years work experience in accounting, budget execution, IT, financial system requirements and analysis, financial planning and reporting, auditing, and internal financial controls. Experience with the Federal Managers' Financial Integrity Act (FMFIA) is preferred.

TRAVEL:  Travel as coordinated with the technical point of contact and approved in writing by the Contracting Officer in advance, is allowed, in accordance with Federal Travel Regulations.  LOCATION:  Work shall be conducted at the CONUS/OCONUS - Washington, DC

  • U.S.  Citizenship Required
  • Excellent oral and written communication skills
  • Proficient with Microsoft Office Products (Microsoft Word, Excel, PowerPoint, Publisher, & Adobe)
  • All ProSidian staff must be determined eligible for a "Facility Access Authorization" (also referred to as an "Employment Authorization") by the USG's designated Security Office.
Additional Information

CORE COMPETENCIES
* Teamwork - ability to foster teamwork collaboratively as a participant, and effectively as a team leader
* Leadership - ability to guide and lead colleagues on projects and initiatives
* Business Acumen - understanding and insight into how organizations perform, including business processes, data, systems, and people
* Communication - ability to effectively communicate to stakeholders of all levels orally and in writing
* Motivation - persistent in pursuit of quality and optimal client and company solutions
* Agility - ability to quickly understand and transition between different projects, concepts, initiatives, or work streams
* Judgment - exercises prudence and insight in decision-making process while mindful of other stakeholders and long-term ramifications
* Organization - ability to manage projects and activity, and prioritize tasks
------------  ------------  ------------
OTHER REQUIREMENTS
* Business Tools - understanding and proficiency with business tools and technology, including Microsoft Office.  The ideal candidate is advanced with Excel, Access, Outlook, PowerPoint and Word, and proficient with Adobe Acrobat, data analytic tools, and Visio with the ability to quickly learn other tools as necessary.
* Business Tools - understanding and proficiency with business tools and technology, including Microsoft Office.  The ideal candidate is advanced with Excel, Access, Outlook, PowerPoint and Word, and proficient with Adobe Acrobat, data analytic tools, and Visio with the ability to quickly learn other tools as necessary.
* Commitment - to work with smart, interesting people with diverse backgrounds to solve the biggest challenges across private, public and social sectors
* Curiosity - the ideal candidate exhibits an inquisitive nature and the ability to question the status quo among a community of people they enjoy and teams that work well together
* Humility - exhibits grace in success and failure while doing meaningful work where skills have impact and make a difference
* Willingness - to constantly learn, share, and grow and to view the world as their classroom
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BENEFITS AND HIGHLIGHTS
At ProSidian, we invest in our employees to help them stay healthy and achieve work-life balance. Our team members receive a comprehensive benefits package that includes Competitive Compensation, Group Health Insurance Health Benefits, 401(k) Retirement Savings Plan Contributions, Vacation and Paid Time off (PTO) Benefits, Pre-Tax Payment Programs, Purchasing Discounts & Savings Plans, a ProSidian Employee & Contractor Referral Bonus Program, Performance Incentives, etc.  Our comprehensive benefits package includes a medical, dental and vision plan.  Our growing list of benefits currently include the following:
* Competitive Compensation:  Pay range begins in the competitive ranges with full Gold Level (Tier 1) Group Medical Benefits, Pretax Employee Benefit Plan, plus performance incentives
* Group Health Insurance Health Benefits:  Group Health Insurance Including Medical, Dental And Vision Insurance: Contributions are deducted from pay on a Pretax basis - Employee and family coverage is available with employer contribution of 50% of Employee (only) premiums under the Health and Vision Plan through Blue Cross Blue Shield NC (Blue Options Medical Plan Code: PB07840 / Metallic Level: Gold - - bcbsnc.com) and Dental Plan (Ameritas - www.ameritas.com).
* 401(k) Retirement Savings Plan: 401(k) Retirement Savings Plans help you save for your retirement.  Eligible employees can make before-tax contributions to the 401(k) Retirement Savings Plan to help you save for retirement.  Contributions are deducted from pay on a pretax basis the employee can contribute up to $18k.  A wide range of investment options are available with a personal financial planner available to assist you. Immediate 100% vesting of both your contribution and the ProSidian matching contribution. The Plan is a Safe Harbor 401(k) Retirement Savings Plan.  ProSidian Consulting participates in a Basic Match: 4% of pay for participants who defer at least 5% of their pay.  The Basic Match is structured as follows:  100% of the first 3% of pay that is contributed; and 50% of the next 2% of pay that is contributed.
* Vacation And Paid Time Off (PTO) Benefits:  The flexibility of Paid Time Off (PTO) lets you set your own priorities. Eligible employees use PTO for vacation, a parent-teacher conference, a doctor's appointment, or any number of events in your life.  Currently these benefits include Vacation/Sick days - 2 weeks | Holidays - 10 Federal Government.
* Pre-Tax Payment Programs:  Pre-Tax Payment Programs currently exist in the form of a Premium Only Plan (POP).  These Plans offer a full Flexible Spending Account (FSA) Plan and a tax benefit for eligible employees.
* Purchasing Discounts & Savings Plans:  We want you to achieve financial success. We offer a Purchasing Discounts & Savings Plan through The ProSidian Corporate Perks Benefit Program - Helping You Do More With Less:  https://ProSidian.CorporatePerks.com.  This provides special discounts for eligible employees on products and services you buy on a daily basis.
* Security Clearance: Due to the nature of our management and operations consulting engagements for Private Companies, Fortune 1,000 Enterprises, and Government Agencies of all sizes; oftentimes there are Security Clearance requirements for Engagement Teams handling sensitive Engagements in the Federal Marketplace.  A Security Clearance is a valued asset in your professional portfolio and adds to your credentials based on past, present, and future work.
* Leverageable Experience and Thought Leadership:  By collaborating with firm leadership, other members of the team, as well as Fellows and collaborating partners in what is a flat organization, you'll make valuable professional connections, interact with clients daily, gain leverageable Experience, and contribute to Thought Leadership while you build a basket of marketable experiences.
* ProSidian Employee & Contractor Referral Bonus Program:  ProSidian Consulting will pay up to $5k for all referrals (payments made after new hire has been employed for 90 days) for candidates submitted through our Employee Referral Program.
* Performance Incentives:  Due to the nature of our management and operations consulting engagements for Private Companies, Fortune 1,000 Enterprises, and Government Agencies of all sizes there are performance incentives associated with each new client that each employee works to pursue and support.
* Flexible Spending Account:  Pending
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ADDITIONAL INFORMATION - See Below Instructions On The Best Way To Apply
ProSidian Consulting is an equal opportunity employer and considers qualified applicants for employment without regard to race, color, creed, religion, national origin, sex, sexual orientation, gender identity and expression, age, disability, or Vietnam era, ...


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About ProSidian Consulting

Sourced by ZipRecruiter

ProSidian is a management and operations consulting firm with a reputation for its strong national practice spanning six solution areas including Risk Management, Energy & Sustainability, Compliance, Business Process, IT Effectiveness, and Talent Management. We help clients improve their operations. Linking strategy to execution, ProSidian assists client leaders in maximizing company return on investment capital through design and execution of operations core to delivering value to customers. Visit www.ProSidian.com or follow the company on Twitter at www.twitter.com/ProSidianfor more information.

Industry

Business schools and computer and management training

Company size

11 - 50 Employees

Headquarters location

Charlotte, NC, US

Year founded

2004

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