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Manager Utilization Management Jobs in Washington, DC

Inova

Registered Nurse (RN) Case Manager

Falls Church, VA

  • Medical

  • Dental

  • Vision

  • PTO

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 ...

New

Pharmacy Careers

Formulary Management Pharmacist

Arlington, VA · On-site

$67 - $80.75/hr

Provide clinical support for utilization management, prior-authorization criteria, and step-therapy guidelines. What You'll Bring * Education: PharmD or Bachelor of Pharmacy. * Licensure: Active U.S ...

Inova

Registered Nurse (RN) Case Manager

Falls Church, VA · On-site

$86K - $140K/yr

  • Medical

  • Dental

  • Vision

  • PTO

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 ...

New

Evolent

Cardiology Physician

Arlington, VA · On-site

$407K - $460K/yr

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 ...

Evolent

Cardiology Physician

Arlington, VA · On-site

$407K - $460K/yr

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 ...

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Showing results 41-60

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

Manager Utilization Management information

See Washington, DC salary details

$44.2K

$103.1K

$189.7K

How much do manager utilization management jobs pay per year?

As of Aug 19, 2026, the average yearly pay for manager utilization management in Washington, DC 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 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 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 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 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 the most commonly searched types of Utilization Management jobs in Washington, DC?

The most popular types of Utilization Management jobs in Washington, DC are:

What are popular job titles related to Manager Utilization Management jobs in Washington, DC?

For Manager Utilization Management jobs in Washington, DC, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in Washington, DC look for?

The top searched job categories for Manager Utilization Management jobs in Washington, DC are:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Washington, DC as of August 2026, with employment types broken down into 85% Full Time, and 15% Contract. Highlights an 100% In-person job distribution, with an average salary of $103,079 per year, or $49.6 per hour.

Physician Advisor - MedStar Multisite

MedStar Health

Annapolis Junction, MD • On-site

$250K - $350K/yr

Other

Medical, Dental, Vision, Retirement, PTO

Posted 16 days ago

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 240 frontline employees who took The Breakroom Quiz

127th of 888 rated healthcare providers

Job description

Physician Advisor – MedStar Multisite

MedStar Health is seeking a Physician Advisor to join our team in a hybrid role supporting hospitals across the MedStar Health System. The Physician Advisor is an essential part of the team, using medical expertise to optimize resource use, reduce length of stay, and prevent clinical denials. Their work ensures patients receive appropriate, timely care.

In this role, you'll:

  • Review patient status, medical necessity, and level of care
  • Lead clinical denial interventions, denial root cause determinations and upstream process improvement initiatives
  • Engage in concurrent and retrospective denials management and peer to peer discussions with payers
  • Drive length of stay improvements in close collaboration with case management and hospital stakeholders
  • Provide education to physicians and other clinicians related to regulatory requirements, appropriate utilization of hospital services, community resources, and alternative level of care
  • Participate in Interdisciplinary Rounds (IDR) with the Healthcare Team as indicated
  • Ensure regulatory compliance of Utilization Management and Discharge planning processes

At MedStar Health, you can expect:

  • A competitive salary
  • Medical, dental, and vision insurance
  • Paid malpractice insurance
  • Paid Time Off
  • Retirement plan

Education/Training:

  • Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) – Board Certification required (Internal Medicine or Emergency Medicine preferred)
  • Preferred: Additional certification in healthcare administration, business, or physician advisory

Experience:

  • Minimum 5 years of direct clinical practice required, hospital based experience preferred
  • Previous experience as physician advisor preferred
  • Strong knowledge of case management, utilization review, regulatory standards, denials management, observation medicine, and length of stay
  • Familiarity with MCG and InterQual clinical criteria

Licensure/Certification:

  • Current medical license in the practicing state
  • Board Certified
  • Preferred: ACPA-C or ABQUARP certification in Physician Advisory (or willingness to obtain within 1 year of hire)

This position has a hiring range of USD $250,000.00 - USD $350,000.00 /Yr.

What Medstar Health employees say

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About Medstar Health

Sourced by ZipRecruiter

MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Columbia, MD, US

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