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Director Utilization Management Jobs in Reston, VA

Decypher

Registered Nurse Case Manager

Bethesda, MD

$40 - $50/hr

Join Decypher and make a direct impact on the health and readiness of Americas service members ... Experience in Referral Management/Utilization Management (RM/UM). * Two to five years of current ...

New

Decypher

Registered Nurse Case Manager

Bethesda, MD · On-site

$40 - $50/hr

Join Decypher and make a direct impact on the health and readiness of Americas service members ... Experience in Referral Management/Utilization Management (RM/UM). * Two to five years of current ...

New

Decypher

Registered Nurse - Case Manager

Bethesda, MD · On-site

$40 - $50/hr

Join Decypher and make a direct impact on the health and readiness of America's service members ... Experience in Referral Management/Utilization Management (RM/UM). * Two to five years of current ...

New

Decypher

Registered Nurse Case Manager

Bethesda, MD · On-site

$40 - $50/hr

Join Decypher and make a direct impact on the health and readiness of America's service members ... Experience in Referral Management/Utilization Management (RM/UM). * Two to five years of current ...

New

Evolent

Internal Medicine Physician

Arlington, VA · On-site

May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. * Participates in on-going ...

Evolent

Radiology Physician

Arlington, VA · On-site

$368K - $460K/yr

May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. * Participates in on-going ...

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Showing results 21-40

All JobsUtilization Management JobsDirector Utilization Management JobsDirector Utilization Management Jobs in Reston, VA

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 Sep 4, 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?

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 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 does a director of utilization management do?

A director of utilization management oversees the review and approval of healthcare services to ensure they are medically necessary and cost-effective. They develop policies, manage teams of reviewers, and collaborate with healthcare providers and insurance companies to optimize patient care and resource utilization.

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:

Director Utilization Management jobs near you
Infographic showing various Director Utilization Management job openings in Reston, VA as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $54,433 per year, or $26.2 per hour.

Remote Cardiology, Physician Clinical Reviewer

Evolent

Arlington, VA • On-site, Remote

Other

Posted 29 days ago

Evolent rating

8.4

Company rating: 8.4 out of 10

Based on 18 frontline employees who took The Breakroom Quiz

73rd of 500 rated business services

Job description

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 environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.



Collaboration Opportunities:  


  • Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician`s input is needed or required. As well as, aids and acts as a resource to Initial Clinical Reviewers.



What You Will Be Doing:


  • Serve as the specialty match reviewer in Cardiology cases, that do not initially meet the applicable medical necessity guidelines, as well as other requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.

  • Provides clinical rationale for standard and expedited appeals.

  • Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request.

  • Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.

  • Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.

  • Participates in on-going training per inter-rater reliability process.

  • May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.

  • On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director.



Qualifications - Required and Preferred:


  • MD/DO/MBBS Degree

  • Current, unrestricted clinical license in medicine or required specialty

  • Obtaining and maintaining medical licenses in the state you reside, as well as, other state licensure required per business needs

  • Active Board Certification in Cardiology, Vascular Surgery or Adult Congenital Heart Disease

  • Strong clinical, management, communication, and organizational skills

  • Energetic and curious with a passion for quality and value in health care

  • Computer Proficiency

  • Minimum of five (5) years’ experience in the practice of Cardiology is preferred

  • Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an “excluded person” by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare.

  • No history of a major disciplinary or legal action by a state medical board

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