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Rn Utilization Management Jobs in Washington (NOW HIRING)

MedStar Health

RN Utilization Mgmt

Washington, DC · On-site

$89.07K - $162.80K/yr

About the Job General Summary of Position The RN Utilization Manager will have 1-2 years of Utilization review- responsible for evaluating the necessity, appropriateness and efficiency of the use of ...

MedStar Health

RN Utilization Management

Washington, DC · On-site

$89.07K - $162.80K/yr

... the management of quality health care resources for achievement of desired outcomes and ... utilization issues to appropriate MedStar personnel. Minimal Qualifications Education * Valid RN ...

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Rn Utilization Management information

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$44.2K

$101.3K

$184.6K

How much do rn utilization management jobs pay per year?

As of May 28, 2026, the average yearly pay for rn utilization management in Washington is $101,348.00, according to ZipRecruiter salary data. Most workers in this role earn between $73,100.00 and $118,400.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as an RN Utilization Management Nurse, and why are they important?

To thrive as an RN Utilization Management Nurse, you need a current RN license, strong clinical assessment skills, and experience in care coordination or case management. Familiarity with utilization review tools, electronic health records, and knowledge of insurance guidelines or InterQual/MCG criteria are typically required. Exceptional communication, critical thinking, and negotiation skills help facilitate collaboration among providers, payers, and patients. These abilities are crucial for ensuring appropriate resource use, compliance with regulations, and optimal patient outcomes.

How does an RN Utilization Management professional typically collaborate with physicians and other healthcare team members?

RN Utilization Management professionals work closely with physicians, case managers, and insurance representatives to ensure patients receive appropriate, high-quality care while managing healthcare costs. They review patient records, communicate clinical findings, and may participate in interdisciplinary meetings to discuss care plans and discharge needs. Building strong relationships and maintaining open lines of communication with the care team is essential for timely authorizations and effective care coordination. This collaborative approach helps optimize patient outcomes and resource utilization.

What are RN Utilization Management nurses?

RN Utilization Management nurses are registered nurses who specialize in reviewing healthcare services to ensure patients receive appropriate and cost-effective care. They evaluate the necessity, efficiency, and quality of medical treatments and procedures, often working with insurance companies, hospitals, or healthcare organizations. Their responsibilities include reviewing patient records, coordinating with clinical staff, making coverage recommendations, and ensuring compliance with healthcare regulations. This role helps manage healthcare costs while maintaining high standards of patient care.

Can you make $200,000 as a nurse?

Registered nurses in utilization management roles typically earn between $70,000 and $120,000 annually, with top earners possibly reaching around $150,000 depending on experience, location, and certifications. Achieving a $200,000 salary usually requires advanced roles, additional certifications, or management positions, which may involve overtime or specialized skills. Salary potential varies based on employer, geographic region, and individual qualifications.

What is the difference between Rn Utilization Management vs Rn Case Management?

AspectRn Utilization ManagementRn Case Management
CertificationsRN license, possibly certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentUtilization review departments, insurance companies, hospitalsCommunity clinics, hospitals, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Both roles require an RN license, but Rn Utilization Management focuses on reviewing the necessity of services, while Rn Case Management emphasizes coordinating patient care. Understanding these differences helps professionals choose the right career path and employers.

What are popular job titles related to Rn Utilization Management jobs in Washington? For Rn Utilization Management jobs in Washington, the most frequently searched job titles are:
What job categories do people searching Rn Utilization Management jobs in Washington look for? The top searched job categories for Rn Utilization Management jobs in Washington are:
Rn Utilization Management jobs near you
Infographic showing various Rn Utilization Management job openings in Washington as of May 2026, with employment types broken down into 4% As Needed, 45% Full Time, 26% Part Time, 24% Contract, and 1% Nights. Highlights an 99% Physical, and 1% Remote job distribution, with an average salary of $101,348 per year, or $48.7 per hour.
RN Utilization Mgmt

RN Utilization Mgmt

MedStar Health

Washington, DC • On-site

$89.07K - $162.80K/yr

Full-time

Posted 8 days ago

Medstar Health rating

7.7

Company rating: 7.7 out of 10

Based on 237 frontline employees who took The Breakroom Quiz

158th of 864 rated healthcare providers

Job description

About the Job
General Summary of Position
The RN Utilization Manager will have 1-2 years of Utilization review- responsible for evaluating the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Responsible for clinical review of acute care services based on Medically Necessity criteria the management of quality health care resources for achievement of desired outcomes and coordination of alternative levels of care in a timely and in the most cost-effective manner.We recruit retain and advance associates with diverse backgrounds skills and talents equitably at all levels.
Primary Duties and Responsibilities
  • Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
  • Acts as a liaison to MedStar Family Choice (MFC) contracted vendors to facilitate care. Identifies gaps in contracted services and develops a plan to access care.
  • Acts as an advocate while assisting members to coordinate and gain access to medical psychiatric psychosocial and other essential services to meet their healthcare needs. Authorizes and monitors covered services according to policy.
  • Attends and participates in MFC staff meetings Clinical Operations department meetings Special Needs Forums work groups etc. as assigned. Provides input completes assignments and shares new findings with other staff. Participates in meetings and on committees and represents the department and MFC in community outreach efforts. Participates in multi-disciplinary quality and service improvement teams.
  • Demonstrates behavior consistent with MedStar Health mission vision goals objectives and patient care philosophy.
  • Demonstrates skill and flexibility in providing coverage for other staff.
  • Identifies inpatients requiring additional services and initiates care with appropriate providers. Demonstrates emphasis on quality patient care during the pre-admission and/or concurrent review process. Authorizes services according to MedStar Family Choice policy.
  • Initiates contact with providers to obtain clinical information to facilitate approval or pending of pre-authorization requests inpatient stays and retrospective reviews.
  • Maintains current knowledge of MFC benefits and enrollment issues in order to accurately coordinate services.
  • Maintains timely and accurate documentation in the clinical software system per Clinical Operations department's policy.
  • Monitors utilization of all services for fraud and abuse.
  • Performs pre-authorization and pharmacy reviews and documents in PBM's system when assigned.
  • Performs telephonic ACD line coverage for Clinical Operations' needs.
  • Performs telephonic inpatient utilization review services; on-site review as indicated. Process includes: assessment planning coordinating and implementation. Monitors for timely provision of services. Assists hospital case management staff with discharge planning as applicable.
  • Makes referrals to Case Management as needed.
  • Sends thorough reviews to Medical Director as appropriate. Coordinates timely review decisions and notifications per policy NCQA standards/guidelines and District of Columbia Contract.
  • Utilizes evidence-based standards in making coverage determinations in individual patient cases; Identifies and reports potential coordination of benefits subrogation third party liability worker's compensation cases etc. Identifies quality risk or utilization issues to appropriate MedStar personnel.

Minimal Qualifications
Education
  • Valid RN license in the District of Columbia; or Maryland required and
  • Bachelor's degree preferred

Experience
  • 1-2 years Recent utilization experience required and
  • 1-2 years Diverse clinical experience required

Licenses and Certifications
  • RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in the District of Columbia; or Maryland Upon Hire required and
  • CCM - Certified Case Manager CCM (Certified Case Manager) Upon Hire preferred

Knowledge Skills and Abilities
  • Proficient computer skills to enter and retrieve data.
  • Ability to create edit and analyze Microsoft office (Word Excel and PowerPoint) preferred.
  • Knowledge of InterQual guidelines preferred.

This position has a hiring range of
USD $89,065.00 - USD $162,801.00 /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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