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Manager Utilization Management Jobs in Washington

MedStar Health

RN Utilization Review

Clinton, MD · On-site

$89K - $162K/yr

About the Job **Must be local to the DC/MD region with acute Utilization Review RN experience ... CCM - Certified Case Manager preferred Knowledge Skills and Abilities * Excellent problem-solving ...

MedStar Health

Director Case Management

Columbia, MD · On-site

The Director of Case Management (DCM) oversees case management activities that may include behavioral health utilization management and care management functions and serves as a liaison to government ...

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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 Aug 7, 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?

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 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 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 August 2026, with employment types broken down into 80% Full Time, 15% Part Time, 1% Temporary, and 4% Contract. Highlights an 87% Physical, 2% Hybrid, and 11% Remote job distribution, with an average salary of $103,079 per year, or $49.6 per hour.

Utilization Management Nurse - Emergency Department

Luminis Health

Annapolis, MD • On-site

Other

Re-posted 29 days ago

Luminis Health rating

7.9

Company rating: 7.9 out of 10

Based on 54 frontline employees who took The Breakroom Quiz

109th of 887 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.

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