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Utilization Reviewer Jobs in Reston, VA (NOW HIRING)

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 ...

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

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 ...

August Healthcare at Iliff

Physical Therapist (PT)

Fairfax, VA · On-site

$1.70K - $2.20K/wk

... and utilization review meetings • Educate residents, families, and staff on therapy goals and plans • Maintain productivity and documentation standards • Support regulatory compliance and ...

Gaudenzia

Program Coordinator

Washington, DC · On-site

Experience with utilization review, quality improvement, or regulatory compliance. * Bilingual or bicultural abilities preferred. * Experience working with underserved or justice-involved populations ...

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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 May 31, 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

Assessor

Springleaf Solutions

Washington, DC • On-site

Contractor

Posted 4 days ago

Job description

Job Summary
The Assessor conducts clinical assessments and intake evaluations, determines service
eligibility, and supports timely connection to care across behavioral health programs.
Key Responsibilities
• Conduct diagnostic and functional assessments and complete treatment planning
documentation.
• Contact consumers within 24 hours of assignment and complete required assessment
components within 48 hours.
• Coordinate with interdisciplinary teams, community partners, and leadership to support
appropriate service placement and continuity of care.
• Maintain accurate, timely, and compliant clinical documentation and communicate
clearly with all stakeholders.
Qualifications
• Master's degree in social work, counseling, nursing, or a related behavioral health field.
• Current licensure or license eligible in Washington, D.C.
• Experience in clinical assessment, diagnosis, service coordination, and behavioral
health documentation.
• 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 team committed to expanding access to high-quality behavioral
health care.

Apply