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Manager Utilization Management Jobs in Washington

Luminis Health

Utilization Management Nurse

Annapolis, MD · On-site

$34 - $55/hr

Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken ...

MedStar Health

RN Team Lead Utilization Review

Clinton, MD · On-site

$89K - $162K/yr

About the Job In-patient Utilization Review RN experience highly preferred. Candidate must live in ... Manages daily assignment ensuring all UM tasks are completed each day. Collaborates with the ...

Inova

Registered Nurse Case Manager

Falls Church, VA · On-site

$86K - $140K/yr

Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities. Responsible for the timely ...

Inova

Registered Nurse Case Manager

Falls Church, VA · On-site

Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities. Responsible for the timely ...

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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Washington

Manager Utilization Management information

See Washington salary details

$44.2K

$103.1K

$189.7K

How much do manager utilization management jobs pay per year?

As of Jul 16, 2026, the average yearly pay for manager utilization management in Washington is $103,079.00, according to ZipRecruiter salary data. Most workers in this role earn between $67,400.00 and $124,000.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Manager Utilization Management, and why are they important?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What is the difference between Manager Utilization Management vs Utilization Review Nurse?

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are some common challenges faced by a Manager in Utilization Management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What does a Manager of Utilization Management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.
What are the most commonly searched types of Utilization Management jobs in Washington? The most popular types of Utilization Management jobs in Washington are:
What are popular job titles related to Manager Utilization Management jobs in Washington? For Manager Utilization Management jobs in Washington, the most frequently searched job titles are:
What job categories do people searching Manager Utilization Management jobs in Washington look for? The top searched job categories for Manager Utilization Management jobs in Washington are:
What cities in Washington are hiring for Manager Utilization Management jobs? Cities in Washington with the most Manager Utilization Management job openings:
Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Washington as of July 2026, with employment types broken down into 1% As Needed, 79% Full Time, 17% Part Time, 1% Temporary, and 2% Contract. Highlights an 85% Physical, 5% Hybrid, and 10% Remote job distribution, with an average salary of $103,079 per year, or $49.6 per hour.
Utilization Management Nurse

Utilization Management Nurse

Luminis Health

Annapolis, MD • On-site

$34 - $55/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

New

Luminis Health rating

8.1

Company rating: 8.1 out of 10

Based on 52 frontline employees who took The Breakroom Quiz

68th of 886 rated healthcare providers

Job description

Position Objective: Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment.
Essential Job Duties:
1. Chart Review:
Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource utilization; enters clinical review in EPIC; maintains close communication with external reviews, care coordinators, and providers; reconciles and records days authorized in EPIC
2. Denial Management:
Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken to avoid denial; assists Care Coordinator in communicating with the patient denied hospital days with work toward resolution and discharge.
3. Care Coordination:
Collaborates with the Care Coordinator to achieve optimal and efficient patient outcomes while decreasing length of stay, avoidable delays and denied days; utilizes Physician Advisor and administrative personnel for unresolved issues; identifies opportunities for expedited appeals and collaborates with the care coordinator and Physician Advisor to resolve payer issues.
4. Process improvement initiatives
Participates in nursing unit and department clinical outcome projects as well as process improvement initiatives of care management.
Educational/Experience Requirements:
  • Bachelor's of Science in Nursing or Associate's degree in Nursing with equivalent experience. BSN must be achieved within 5 years of start date in the role.
  • Three years of clinical nursing in an acute care hospital setting.

RequiredLicense/Certifications:
  • Current RN license from Maryland Board of Nursing.

Working Conditions, Equipment, Physical Demands:
There is a reasonable expectation that employees in this position will be exposed to blood-borne pathogens.
Physical Demands -
The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.
The above job description is an overview of the functions and requirements for this position. This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.
Pay Range
$34-$55 USD
Luminis Health Benefits Overview:• Medical, Dental, and Vision Insurance
• Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
• Paid Time Off
• Tuition Assistance Benefits
• Employee Referral Bonus Program
• Paid Holidays, Disability, and Life/AD&D for full-time employees
• Wellness Programs
• Employee Assistance Programs and more
*Benefit offerings based on employment status
Opt-in for text notifications!Luminis Health's two-way SMS texting platform lets you receive notifications and messages from our Talent Acquisition team directly on your phone.
To enable this feature, select "yes" when asked to "opt-in to receive text messages" and to "Receive updates from a recruiter about this job via SMS" when completing your application. Once you are opted in, you can easily opt-out at any time. Standard text messaging rates may apply based on the candidate's mobile carrier plan. Luminis Health is not responsible for any charges incurred by the recipient. Candidates are encouraged to review their mobile carrier's plan for applicable text messaging rates and usage charges.

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