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Medstar Health Utilization Review Jobs (NOW HIRING)

Sentara Health Plans

$60 - $80/hr

Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse. The Utilization Review Nurse is responsible for utilization management services within the scope of licensure.

HealthCare Support

Utilization Management

Houston, TX · On-site

$38 - $40.86/hr

Behavioral Health Utilization Review RN HealthCare Support is actively seeking a Remote BH Utilization Review RN to fill an opening with a Managed Care Company . Daily Responsibilities for Remote BH ...

Umpqua Health

Utilization Review Clinician

Roseburg, OR · On-site

$80 - $100/hr

Utilization Review Clinician Remote Ability to travel on-site to 3031 NE STEPHENS ST. ROSEBURG, OR ... Evaluate behavioral health and substance use disorder services to determine medical necessity ...

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Medstar Health Utilization Review information

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How much do medstar health utilization review jobs pay per hour?

As of Sep 8, 2026, the average hourly pay for medstar health utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is a MedStar Health utilization review?

A Medstar Health Utilization Review is a process used by Medstar Health to evaluate the necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities. Utilization review professionals assess patient records, treatment plans, and insurance requirements to ensure that patients receive the right care at the right time, while also helping to manage healthcare costs. This process helps maintain quality standards, prevent unnecessary treatments, and ensure compliance with regulations and payer policies.

What are some common challenges faced by utilization review professionals at MedStar Health, and how can these be managed?

Utilization Review professionals at Medstar Health often encounter challenges such as keeping up with frequently changing healthcare regulations, managing high caseloads, and ensuring effective communication with both clinical teams and insurance providers. Successfully managing these challenges typically involves staying current with industry guidelines through ongoing education, utilizing support from multidisciplinary teams, and leveraging Medstar Health’s robust electronic health record systems. Building strong collaboration skills and being proactive in documenting reviews can also help streamline workflows and improve efficiency.

What are the key skills and qualifications needed to thrive as a utilization review specialist at MedStar Health, and why are they important?

To thrive as a Utilization Review Specialist at MedStar Health, you need a clinical background (such as RN or LPN licensure), strong knowledge of medical necessity criteria, and experience in case management or utilization review. Familiarity with electronic medical records (EMR) systems, InterQual or MCG guidelines, and regulatory compliance tools is typically required. Attention to detail, critical thinking, and effective communication are essential soft skills for collaborating with healthcare teams and ensuring accurate assessments. These skills and qualifications ensure appropriate resource use, regulatory compliance, and optimal patient outcomes within the healthcare system.

What is the difference between Medstar Health Utilization Review vs Medstar Health Case Manager?

AspectMedstar Health Utilization ReviewMedstar Health Case Manager
Primary RoleAssessing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning
CredentialsRN, licensed healthcare professionalRN, social worker, or licensed healthcare professional
Work EnvironmentInsurance companies, hospitals, or health plansHospitals, clinics, or community health settings
FocusUtilization review and approvalPatient advocacy and care coordination

While both roles involve healthcare professionals, Medstar Health Utilization Review focuses on evaluating the necessity of services, whereas Medstar Health Case Managers coordinate ongoing patient care and discharge planning. Both roles require similar credentials and often work within the same healthcare environment, but their primary responsibilities differ.

What are popular job titles related to Medstar Health Utilization Review jobs?

For Medstar Health Utilization Review jobs, the most frequently searched job titles are:

Infographic showing various Medstar Health Utilization Review job openings in the United States as of September 2026, with employment types broken down into 2% As Needed, 77% Full Time, 16% Part Time, and 5% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Physician Advisor - MedStar Multisite

Annapolis Junction, MD • On-site

MedStar Health
Health Care and Social Assistance • 10K+ employees
Learn more about MedStar Healthexternal

$250K - $350K/yr

Other

Medical, Dental, Vision, Retirement, PTO

Re-posted 6 days ago

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 241 frontline employees who took The Breakroom Quiz

137th of 898 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.

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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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