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Director Utilization Management Jobs in Reston, VA

Bcbsa

Director, Trade Client Relations

Gaithersburg, MD · Remote

$155K - $175K/yr

The Trade Client Strategy Director liaises with Synergie Participants and manages clinical policies ... and utilization management strategies * Client Relations - Serve as Trade's primary point of ...

Pharmacy Careers

Appeals Pharmacist (Remote)

Silver Spring, MD · On-site

$59.25 - $72/hr

Collaborate with physicians, nurses, and medical directors during case reviews. * Track and report ... Managed care or utilization management preferred. Hospital, ambulatory, and community pharmacists ...

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 ...

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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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 Aug 23, 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.

Physician Internal Medicine - Competitive Salary

Sound Physicians

Alexandria, VA • On-site

Other

Medical, Retirement, PTO

Re-posted 8 days ago

Job description

Join our Medical Group as an Executive Leader as a Medical Director, Advisory Services - A Role Designed for You

An experienced physician leader to provide on-site advisory services and lead utilization management (UM), compliance, and clinical documentation improvement (CDI) efforts to our partner hospitals. In this unique role, you will provide advisory services and the opportunity to work with hospital administration to identify and address performance improvement opportunities, potentially including length of stay, readmissions, improved documentation, and regulatory compliance. 

Team Collaboration:

  • Together, collaborate to provide expert guidance and drive better outcomes.
  • Our physician advisors operate across multiple states, including Arizona, California, Florida, Kentucky, Nevada, and West Virginia, collaborating with partner hospitals to improve services and outcomes.
  • The team leads utilization management (UM) efforts, clinical documentation improvement (CDI), education, and regulatory compliance. Our role is to drive performance improvements in length of stay, readmissions, and documentation. 

Qualifications:

  • MD or DO licensure within the state of employment.
  • Experience in Utilization Management, compliance, and clinical documentation preferred.
  • Strong leadership, education, and collaboration skills.
  • Board Certification (base specialty) recognized by ABMS or ABQAURP.
  • Education on the application of medical necessity criteria within three months of hire.
  • Three years of post-residency experience as a physician advisor preferred.
  • Authorized to work in the United States.

Scheduling:

  • Monday - Friday, providing a healthy work-life balance.

Key Responsibilities:

  • Provide leadership and oversight of advisory services. 
  • Serve as a visible physician leader and advocate for improved regulatory compliance, improved documentation, and improved utilization of hospital resources. 
  • Provide support to address and reduce payer denials. 
  • Develop action plans on performance improvement opportunities. 
  • Provide one-on-one as well as group education to the medical staff. 
  • Provide timely and effective consultation to case management, CDI specialists, physicians, and other staff at the hospital with documented determinations and observations.

Rewards and Compensation:

  • Competitive base salary, commensurate with experience.
  • Health benefits, CME allowance, PTO, and 401k.


Cindy Mitchum, Clinical Recruiter | cmitchum@soundphysicians.com | (706) 799-3592

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About Sound Physicians

Sourced by ZipRecruiter

Sound Physicians is a leading physician partner to hospitals, health plans, physician groups, and post-acute providers seeking to transform outcomes for acute episodes of care. For 20 years our high-performing and affordable care models have combined physician leadership, clinical process, technology and analytics to consistently improve clinical and financial performance. We are pioneers in value, working together with our partners and community providers to bridge gaps in care, from hospital to home.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Tacoma, WA, US

Year founded

2001

Social media

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