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Director Utilization Management Jobs in Reston, VA

Evolent

Internal Medicine Physician

Arlington, VA

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

$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 ...

Evolent

Oncology - Radiation Physician

Arlington, VA

Field Medical Director, Radiation Oncology As a FMD, 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 ...

Evolent

Oncology - Radiation Physician

Arlington, VA · On-site

Field Medical Director, Radiation Oncology As a FMD, 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 ...

UHS

Utilization Review Coordinator

Washington, DC · On-site

$33.60 - $50.40/hr

Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...

UHS

Utilization Review Coordinator

Washington, DC

Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...

UHS

Utilization Review Coordinator

Washington, DC

Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...

Inova

Registered Nurse (RN) Case Manager

Fairfax, VA

Uses utilization management techniques to determine the medical necessity, appropriateness and ... Documents key clinical path variances and outcomes which relate to areas of direct responsibility ...

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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 Jul 25, 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.
REMOTE Physician Clinical Reviewer-Radiology

REMOTE Physician Clinical Reviewer-Radiology

Evolent

Arlington, VA

Other

Posted 22 days ago

Evolent rating

8.4

Company rating: 8.4 out of 10

Based on 18 frontline employees who took The Breakroom Quiz

58th of 454 rated business services

Job description

As a FMD, Radiology 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.



What You Will Be Doing:


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

  • Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals.

  • 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.

  • Aids and acts as a resource to Initial Clinical Reviewers.

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

  • 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 training per inter-rater reliability process.



Qualifications:


  • MD/DO/MBBS

  • Minimum of five (5) years’ experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is preferred

  • Current, unrestricted clinical license in home state medicine or required specialty-

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

  • Active Board Certification by an accredited organization

  • Strong clinical, management, communication, and organizational skills

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

  • Computer Proficiency

  • 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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