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Utilization Reviewer Jobs in Reston, VA (NOW HIRING)

Inova

Director, Case Management

Leesburg, VA · On-site

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 ...

Trinityhealth

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 ...

Trinityhealth

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 ...

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 ...

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

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 ...

Networks Connect

Case Manager (RN)

Washington, DC · On-site

$85K - $96K/yr

Clinical reviews and utilization management using nationally recognized criteria * Payer coordination - authorizations, denials, and communication around level-of-care changes to limit financial risk ...

Springleaf Solutions

Intake Assessor Specialist

Washington, DC · On-site

$18.50 - $25/hr

... 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

Intake Assessor Specialist

Washington, DC · On-site

$20 - $27/hr

... 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 ...

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Showing results 1-20

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 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.
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
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.
Director, Case Management

Director, Case Management

Inova

Leesburg, VA • On-site

Full-time

Posted 15 days ago

Inova Health System rating

7.6

Company rating: 7.6 out of 10

Based on 246 frontline employees who took The Breakroom Quiz

188th of 877 rated healthcare providers

Job description


The Director of Case Management leads and coordinates key strategic development and functional services to support department objectives and organizational goals. Maintains effective and responsive relationships with patients, attending medical staff and other departments. Manages department finances, including budgeting and control of salary, non-salary and capital investment expenses. Manages professional staff including day to day supervision, team member relations and staff development.
Job Responsibilities:
  • 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 the preparation, distribution and interpretation of monthly reports on productivity and Case Management targets.
  • Leads the management, measurement and continuous quality improvement of LOS, avoidable days and denial management.
  • Oversees the maintenance of Case Management database and use of Case Management software.
  • Responds promptly to requests from other departments within the operating unit and maintains cooperative relationships with corresponding departments at other operating units.
  • Ensures adherence to service excellence standards and the provision of outstanding service to internal/external customers.
  • Manages reimbursement and contract issues through collaboration with managed care contracting.
  • Selects, hires and trains staff to perform assigned functions at a competent level to include Case Managers and administrative staff.

Minimum Requirements:
Experience - Five years of experience in case management or acute care to include at least one year of management experience.
Education - Bachelor's Degree
Preferred Requirements:
CCM/ACMA certification
2 years Progressive leadership experience in case management, utilization review, or care coordination within an acute care hospital setting
About Us
We are Inova, Northern Virginia's leading nonprofit healthcare provider. Every day, our 26,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better - to shape a more compassionate future for healthcare.
Inova Health System is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.

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