RN Utilization Management
Washington, DC · On-site
$89.07K - $162.80K/yr
Makes referrals to Case Management as needed ... Sends thorough reviews to Medical Director as appropriate. Coordinates timely review decisions and ...
RN Utilization Management
Washington, DC · On-site
$89.07K - $162.80K/yr
Makes referrals to Case Management as needed ... Sends thorough reviews to Medical Director as appropriate. Coordinates timely review decisions and ...
RN Utilization Mgmt
Washington, DC · On-site
$89.07K - $162.80K/yr
About the Job General Summary of Position The RN Utilization Manager will have 1-2 years of ... Sends thorough reviews to Medical Director as appropriate. Coordinates timely review decisions and ...
RN Utilization Mgmt
Washington, DC · On-site
$89.07K - $162.80K/yr
About the Job General Summary of Position The RN Utilization Manager will have 1-2 years of ... Sends thorough reviews to Medical Director as appropriate. Coordinates timely review decisions and ...
Clinical Medical Director
Leesburg, VA · On-site
$80.90K - $110.20K/yr
Familiarity with utilization management criteria (InterQual, MCG/Milliman) and clinical appeals ... Direct experience with surprise billing, IDR, IRO, or IME (Independent Medical Examination ...
Quick apply
Clinical Medical Director
Leesburg, VA · On-site
$80.90K - $110.20K/yr
Familiarity with utilization management criteria (InterQual, MCG/Milliman) and clinical appeals ... Direct experience with surprise billing, IDR, IRO, or IME (Independent Medical Examination ...
Responsible for both the management of resources and the achievement of desired outcomes for members with on-going communication to the Director of Utilization Management, the Chief Medical Director ...
Responsible for both the management of resources and the achievement of desired outcomes for members with on-going communication to the Director of Utilization Management, the Chief Medical Director ...
... and utilization management. The Vice President, Clinical Policy and Risk Management will oversee a department comprising 5 direct reports that lead CM/UM Risk Management, UM and CM audit teams ...
... and utilization management. The Vice President, Clinical Policy and Risk Management will oversee a department comprising 5 direct reports that lead CM/UM Risk Management, UM and CM audit teams ...
... and utilization management. The Vice President, Clinical Policy and Risk Management will oversee a department comprising 5 direct reports that lead CM/UM Risk Management, UM and CM audit teams ...
... and utilization management. The Vice President, Clinical Policy and Risk Management will oversee a department comprising 5 direct reports that lead CM/UM Risk Management, UM and CM audit teams ...
... and utilization management. The Vice President, Clinical Policy and Risk Management will oversee a department comprising 5 direct reports that lead CM/UM Risk Management, UM and CM audit teams ...
... and utilization management. The Vice President, Clinical Policy and Risk Management will oversee a department comprising 5 direct reports that lead CM/UM Risk Management, UM and CM audit teams ...
... and utilization management. The Vice President, Clinical Policy and Risk Management will oversee a department comprising 5 direct reports that lead CM/UM Risk Management, UM and CM audit teams ...
... and utilization management. The Vice President, Clinical Policy and Risk Management will oversee a department comprising 5 direct reports that lead CM/UM Risk Management, UM and CM audit teams ...
... and utilization management. The Vice President, Clinical Policy and Risk Management will oversee a department comprising 5 direct reports that lead CM/UM Risk Management, UM and CM audit teams ...
... and utilization management. The Vice President, Clinical Policy and Risk Management will oversee a department comprising 5 direct reports that lead CM/UM Risk Management, UM and CM audit teams ...
... and utilization management. The Vice President, Clinical Policy and Risk Management will oversee a department comprising 5 direct reports that lead CM/UM Risk Management, UM and CM audit teams ...
... and utilization management. The Vice President, Clinical Policy and Risk Management will oversee a department comprising 5 direct reports that lead CM/UM Risk Management, UM and CM audit teams ...
Utilization management, medical necessity, and continuity of care * Supervision and performance of ... Direct influence over agency-wide clinical strategy * Authority to stabilize, scale, and elevate ...
Quick apply
Utilization management, medical necessity, and continuity of care * Supervision and performance of ... Direct influence over agency-wide clinical strategy * Authority to stabilize, scale, and elevate ...
Utilization management, medical necessity, and continuity of care * Supervision and performance of ... Direct influence over agency-wide clinical strategy * Authority to stabilize, scale, and elevate ...
Quick apply
Utilization management, medical necessity, and continuity of care * Supervision and performance of ... Direct influence over agency-wide clinical strategy * Authority to stabilize, scale, and elevate ...
Field Medical Director, Vascular Surgery
Washington, DC · On-site
$140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
Field Medical Director, Vascular Surgery
Washington, DC · On-site
$140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
Director of Clinical Services (LICSW or LPC Required) for a District of Columbia Department of ... Utilization management, medical necessity, and continuity of care * Supervision and performance of ...
Quick apply
Director of Clinical Services (LICSW or LPC Required) for a District of Columbia Department of ... Utilization management, medical necessity, and continuity of care * Supervision and performance of ...
As a Field Medical Director, MSK Surgery you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
As a Field Medical Director, MSK Surgery you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
... utilization management, risk adjustment, population health, SDoH, Stars, member journey and ... director levels. * Drive business development and practice growth, identifying expansion ...
... utilization management, risk adjustment, population health, SDoH, Stars, member journey and ... director levels. * Drive business development and practice growth, identifying expansion ...
... utilization management, risk adjustment, population health, SDoH, Stars, member journey and ... director levels. * Drive business development and practice growth, identifying expansion ...
... utilization management, risk adjustment, population health, SDoH, Stars, member journey and ... director levels. * Drive business development and practice growth, identifying expansion ...
Director of Case Management
Dulles, VA · On-site
$120K - $130K/yr
Director of Case Management - Northern Virginia Salary: $120,000 - $130,000 + Quarterly Bonus ... Oversee utilization review and discharge planning processes * Ensure compliance with regulatory and ...
Quick apply
Director of Case Management
Dulles, VA · On-site
$120K - $130K/yr
Director of Case Management - Northern Virginia Salary: $120,000 - $130,000 + Quarterly Bonus ... Oversee utilization review and discharge planning processes * Ensure compliance with regulatory and ...
Director of Case Management
$120K - $130K/yr
Director of Case Management - Northern Virginia Salary: $120,000 - $130,000 + Quarterly Bonus ... Oversee utilization review and discharge planning processes * Ensure compliance with regulatory and ...
Quick apply
Director of Case Management
$120K - $130K/yr
Director of Case Management - Northern Virginia Salary: $120,000 - $130,000 + Quarterly Bonus ... Oversee utilization review and discharge planning processes * Ensure compliance with regulatory and ...
Director Utilization Management information
See Reston, VA salary details
$18.7K - $25K
1% of jobs
$25K - $31.2K
3% of jobs
$31.2K - $37.5K
11% of jobs
$41.5K is the 25th percentile. Wages below this are outliers.
$37.5K - $43.7K
16% of jobs
$43.7K - $49.9K
15% of jobs
The median wage is $51.8K / yr.
$49.9K - $56.2K
16% of jobs
$61.3K is the 75th percentile. Wages above this are outliers.
$56.2K - $62.4K
17% of jobs
$62.4K - $68.7K
9% of jobs
$68.7K - $74.9K
7% of jobs
$74.9K - $81.1K
3% of jobs
$81.1K - $87.4K
2% of jobs
$18.7K
$54.4K
$87.4K
How much do director utilization management jobs pay per year?
As of May 30, 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 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 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 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.
More about Director Utilization Management jobs
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:
What cities near Reston, VA are hiring for Director Utilization Management jobs? Cities near Reston, VA with the most Director Utilization Management job openings:
$89.07K - $162.80K/yr
Full-time
Posted 5 days ago
Medstar Health rating
7.7
Based on 237 frontline employees who took The Breakroom Quiz
158th of 864 rated healthcare providers
Job description
About the Job
General Summary of Position
Responsible for evaluating the necessity appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of acute care services based on Medically Necessity criteria the management of quality health care resources for achievement of desired outcomes and coordination of alternative levels of care in a timely and in the most cost-effective manner.We recruit retain and advance associates with diverse backgrounds skills and talents equitably at all levels.
Primary Duties and Responsibilities
Minimal Qualifications
Education
Experience
Licenses and Certifications
Knowledge Skills and Abilities
This position has a hiring range of
USD $89,065.00 - USD $162,801.00 /Yr.
General Summary of Position
Responsible for evaluating the necessity appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of acute care services based on Medically Necessity criteria the management of quality health care resources for achievement of desired outcomes and coordination of alternative levels of care in a timely and in the most cost-effective manner.We recruit retain and advance associates with diverse backgrounds skills and talents equitably at all levels.
Primary Duties and Responsibilities
- Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
- Acts as a liaison to MedStar Family Choice (MFC) contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care.
- Acts as an advocate while assisting members to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy.
- Attends and participates in MFC staff meetings Clinical Operations department meetings Special Needs Forums work groups etc. as assigned. Provides input completes assignments and shares new findings with other staff. Participates in meetings and on committees and represents the department and MFC in community outreach efforts. Participates in multi-disciplinary quality and service improvement teams.
- Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy.
- Demonstrates skill and flexibility in providing coverage for other staff.
- Identifies inpatients requiring additional services and initiates care with appropriate providers. Demonstrates emphasis on quality patient care during the pre-admission and/or concurrent review process. Authorizes services according to MedStar Family Choice policy.
- Initiates contact with providers to obtain clinical information to facilitate approval or pending of pre-authorization requests inpatient stays and retrospective reviews.
- Maintains current knowledge of MFC benefits and enrollment issues in order to accurately coordinate services.
- Maintains timely and accurate documentation in the clinical software system per Clinical Operations department's policy.
- Monitors utilization of all services for fraud and abuse.
- Performs pre-authorization and pharmacy reviews and documents in PBM's system when assigned.
- Performs telephonic ACD line coverage for Clinical Operations' needs.
- Performs telephonic inpatient utilization review services; on-site review as indicated. Process includes: assessment planning coordinating and implementation. Monitors for timely provision of services. Assists hospital case management staff with discharge planning as applicable.
- Makes referrals to Case Management as needed.
- Sends thorough reviews to Medical Director as appropriate. Coordinates timely review decisions and notifications per policy NCQA standards/guidelines and District of Columbia Contract.
- Utilizes evidence-based standards in making coverage determinations in individual patient cases; Identifies and reports potential coordination of benefits subrogation third party liability worker's compensation cases etc. Identifies quality risk or utilization issues to appropriate MedStar personnel.
Minimal Qualifications
Education
- Valid RN license in the District of Columbia; or Maryland required and
- Bachelor's degree preferred
Experience
- 1-2 years Recent utilization experience required and
- 1-2 years Diverse clinical experience required
Licenses and Certifications
- RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia; or Maryland Upon Hire required and
- CCM - Certified Case Manager CCM (Certified Case Manager) Upon Hire preferred
Knowledge Skills and Abilities
- Proficient computer skills to enter and retrieve data.
- Ability to create edit and analyze Microsoft office (Word Excel and PowerPoint) preferred.
- Knowledge of InterQual guidelines preferred.
This position has a hiring range of
USD $89,065.00 - USD $162,801.00 /Yr.
What Medstar Health employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
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