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Director Utilization Management Jobs in Reston, VA

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Director Utilization Management information

See Reston, VA salary details

$18.7K

$54.4K

$87.4K

How much do director utilization management jobs pay per year?

As of Jul 22, 2026, the average yearly pay for director utilization management in Reston, VA is $54,433.00, according to ZipRecruiter salary data. Most workers in this role earn between $41,600.00 and $62,400.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Director Utilization Management position, and why are they important?

To thrive as a Director Utilization Management, you need a strong background in healthcare administration, case management, and data-driven decision-making, often supported by a clinical degree and several years of management experience. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as CCM or ACM are typically valued. Exceptional leadership, communication, and problem-solving skills distinguish top performers in this role. These competencies are vital for optimizing resource use, ensuring regulatory compliance, and leading teams to meet quality care standards.

What is a Director Utilization Management job?

A Director of Utilization Management oversees the review and approval of medical services to ensure they are necessary, efficient, and cost-effective. They develop strategies to improve care quality while managing healthcare costs, working closely with providers, payers, and regulatory bodies. Their responsibilities include policy development, compliance with healthcare regulations, and leading a team of utilization review professionals. This role is common in hospitals, insurance companies, and managed care organizations.

What are the typical daily responsibilities of a Director Utilization Management?

A Director Utilization Management generally oversees a team responsible for reviewing patient care to ensure appropriate resource use and compliance with payer requirements. Daily tasks may include analyzing utilization data, developing policy and process improvements, collaborating with clinical and administrative staff, and addressing escalated cases or issues. Directors frequently attend strategy meetings, conduct staff training, and engage with external partners like insurance providers. This role requires balancing administrative oversight with hands-on problem solving to support both cost efficiency and quality patient care.

What are the most commonly searched types of Utilization Management jobs in Reston, VA? The most popular types of Utilization Management jobs in Reston, VA are:
What are popular job titles related to Director Utilization Management jobs in Reston, VA? For Director Utilization Management jobs in Reston, VA, the most frequently searched job titles are:
What job categories do people searching Director Utilization Management jobs in Reston, VA look for? The top searched job categories for Director Utilization Management jobs in Reston, VA are:
Director Utilization Management jobs near you
Infographic showing various Director Utilization Management job openings in Reston, VA as of July 2026, with employment types broken down into 1% As Needed, 82% Full Time, 15% Part Time, 1% Temporary, and 1% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $54,433 per year, or $26.2 per hour.
Director Utilization Management MedStar Family Choice

Director Utilization Management MedStar Family Choice

MedStar Health

Washington, DC • On-site

$120K - $238K/yr

Full-time

Posted 20 days ago

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 238 frontline employees who took The Breakroom Quiz

132nd of 888 rated healthcare providers

Job description

About the Job
General Summary of Position
The Director of Utilization Management (UM) provides strategic and operational leadership for the health plan's centralized utilization management function across both plans. This role ensures appropriate evidence-based utilization of services while maintaining regulatory compliance improving quality outcomes and driving cost-effective delivery. Under a centralized clinical operation model the Director aligns UM process across plans standardizes workflows optimizes technology and integrates closely with Case Management Pharmacy Quality and Provider Relations to support enterprise-wide performance goals.
Primary Duties and Responsibilities
  • Leads enterprise-wide utilization management strategy across all health plans under a centralized clinical operation model.
  • Standardizes UM policies workflows and clinical criteria application to ensure consistency and scalability across markets.
  • Oversees prior authorization concurrent review retrospective review to ensure timely and compliant determinations.
  • Ensures compliance with state Medicaid NCQA CMS and contractual requirements including turnaround time standards.
  • Partners with medical directors to ensure appropriate clinical decision-making and consistent application of medical necessity criteria.
  • Develops and monitors UM performance dashboards including denial rates overturn rates length of stay and turnaround times.
  • Drives medical expense management initiatives by identifying utilization trends and implementing targeted interventions.
  • Collaborates with Case Management leadership to ensure seamless transitions between UM and care coordination functions.
  • Partners with pharmacy leadership to align utilization controls on high-cost drugs and specialty therapies.
  • Oversees hospital utilization management including inpatient admission appropriateness DRG optimization and reduction strategies.
  • Identifies and implements process improvement initiatives to increase operational efficiency and reduce variability.
  • Prepares for a lead regulatory audits accreditation reviews and corrective action plans related to UM functions.
  • Monitors and ensures compliance with evidence-based clinical criteria tools (e.g. InterQual ASAM) and internal policies.
  • Leads workforce planning and staffing models to ensure appropriate caseload distribution and productivity standards.
  • Supervises and develops UM managers and supervisors including performance evaluations and professional development.
  • Collaborates with Finance and Actuarial team to analyze utilization trends cost drivers and forecast medical expense impact.
  • Supports value-based payment models and alternative payment initiatives by aligning UM process with performance metrics.
  • Develops escalation and peer review process to manage complex or high-risk clinical determinations.
  • Ensures culturally competent and member- center decision-making balancing access quality and cost stewardship.
  • Provides executive-level reporting and strategic recommendation to the VP of Clinical Operations and senior leadership
    • Minimal Qualifications
    Education
    • Bachelor's degree Bachelor's degree in Nursing Social Work or related healthcare field required
    • Master's degree Master's degree in Nursing (MSN) Public Health (MPH) Healthcare Administration (MHA) Business Administration (MBA) or related field preferred
    Experience
    • 8-10 years years of managed care experience required and
    • 5-7 years Minimum 5 years utilization management leadership required and
    • Experience with centralized operations preferred and
    • Demonstrated experience in Medicaid managed care preferred
    Licenses and Certifications
    • RN - Registered Nurse - State Licensure and/or Compact State Licensure in MD/DC Upon Hire required
    Knowledge Skills and Abilities
    • Deep understanding of state Medicaid CMS and NCQA requirements
    • Experience in medical necessity criteria tools (InterQual)
    • Strong data analytics and financial acumen
    • Change management expertise
    • Excellent executive communication skills.

    This position has a hiring range of
    USD $120,702.00 - USD $238,222.00 /Yr.

    What Medstar Health employees say

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    About Medstar Health

    Sourced by ZipRecruiter

    MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

    Industry

    Health care and social assistance

    Company size

    10,000+ Employees

    Headquarters location

    Columbia, MD, US

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