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Um Coordinator Jobs in Reston, VA (NOW HIRING)

Amerihealth Caritas

Clinical Care Reviewer UM

Washington, DC · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of services, identifies care coordination opportunities, and ensures compliance with medical policies.

AmeriHealth Caritas

Clinical Care Reviewer UM

Washington, DC · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Using professional judgment, the Utilization Management Reviewer assesses the appropriateness of services, identifies care coordination opportunities, and ensures compliance with medical policies.

MedStar Health

Field RN Case Manager

Washington, DC · On-site

$89K - $113K/yr

... UM) activities. Completes field-based member assessments and identifies activities and ... Oversees daily weekly and monthly functions of Field Case Manager coordinating member assessments ...

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All JobsUm JobsUm Coordinator JobsUm Coordinator Jobs in Reston, VA

Um Coordinator information

See Reston, VA salary details

$12

$25

$42

How much do um coordinator jobs pay per hour?

As of Aug 15, 2026, the average hourly pay for um coordinator in Reston, VA is $25.18, according to ZipRecruiter salary data. Most workers in this role earn between $19.52 and $29.52 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a UM coordinator, and why are they important?

To thrive as a UM (Utilization Management) Coordinator, you need strong knowledge of healthcare regulations, case management, and medical terminology, usually supported by a nursing degree or healthcare certification. Familiarity with UM software systems, electronic health records (EHRs), and insurance claims processing tools is typically required. Excellent communication, critical thinking, and organizational skills help UM Coordinators effectively manage cases and collaborate with providers and payers. These skills ensure that patient care is efficiently coordinated, medically necessary, and compliant with regulatory standards.

What is a UM coordinator?

A UM Coordinator, or Utilization Management Coordinator, is a healthcare professional responsible for reviewing medical cases to ensure that patients receive appropriate, cost-effective care. They assess treatment plans, coordinate with healthcare providers, and ensure compliance with insurance policies and regulatory guidelines. UM Coordinators play a key role in managing the approval process for medical procedures and services, helping to balance patient needs with organizational resources. Their work helps to improve patient outcomes while controlling healthcare costs.

How does a UM coordinator typically collaborate with healthcare providers and insurance companies?

A UM Coordinator serves as a key liaison between healthcare providers and insurance companies to ensure that medical services meet established criteria for coverage. On a daily basis, you’ll review clinical documentation, communicate with physicians and nurses to clarify treatment plans, and coordinate authorizations with payers. This role requires strong communication skills to resolve discrepancies, advocate for patient care, and maintain compliance with regulatory standards. Effective collaboration is essential to streamline care delivery and manage costs within the healthcare team.

What is the difference between Um Coordinator vs Medical Office Coordinator?

AspectUm CoordinatorMedical Office Coordinator
Required CredentialsTypically requires a degree or certification in healthcare administration or related fieldOften requires medical office administration certification or related experience
Work EnvironmentWorks primarily in outpatient clinics, hospitals, or healthcare facilitiesWorks in medical offices, clinics, or healthcare administrative settings
Employer & Industry UsageUsed in healthcare organizations managing ultrasound or imaging servicesCommon in medical practices managing administrative and clerical tasks
Common Search & Comparison IntentPeople compare roles related to healthcare coordination and ultrasound managementPeople compare administrative roles within medical practices

The Um Coordinator and Medical Office Coordinator roles share similarities in healthcare settings and require related certifications. However, the Um Coordinator typically focuses on ultrasound or imaging services, while the Medical Office Coordinator handles broader administrative tasks in medical offices. Both roles are essential for smooth healthcare operations but differ in specific responsibilities and work environments.

What are popular job titles related to Um Coordinator jobs in Reston, VA?

For Um Coordinator jobs in Reston, VA, the most frequently searched job titles are:

What job categories do people searching Um Coordinator jobs in Reston, VA look for?

The top searched job categories for Um Coordinator jobs in Reston, VA are:

What cities near Reston, VA are hiring for Um Coordinator jobs?

Cities near Reston, VA with the most Um Coordinator job openings:

Um Coordinator jobs near you
Infographic showing various Um Coordinator job openings in Reston, VA as of August 2026, with employment types broken down into 100% Full Time. Highlights an 86% In-person, 5% Hybrid, and 9% Remote job distribution, with an average salary of $52,383 per year, or $25.2 per hour.

Director Utilization Management MedStar Family Choice

MedStar Health

Washington, DC • On-site

$120K - $238K/yr

Full-time

Re-posted 14 days ago

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 239 frontline employees who took The Breakroom Quiz

130th of 887 rated healthcare providers

Job description

About the Job
General Summary of Position
The Director of Utilization Management (UM) provides strategic and operational leadership for the health plan's centralized utilization management function across both plans. This role ensures appropriate evidence-based utilization of services while maintaining regulatory compliance improving quality outcomes and driving cost-effective delivery. Under a centralized clinical operation model the Director aligns UM process across plans standardizes workflows optimizes technology and integrates closely with Case Management Pharmacy Quality and Provider Relations to support enterprise-wide performance goals.
Primary Duties and Responsibilities
  • Leads enterprise-wide utilization management strategy across all health plans under a centralized clinical operation model.
  • Standardizes UM policies workflows and clinical criteria application to ensure consistency and scalability across markets.
  • Oversees prior authorization concurrent review retrospective review to ensure timely and compliant determinations.
  • Ensures compliance with state Medicaid NCQA CMS and contractual requirements including turnaround time standards.
  • Partners with medical directors to ensure appropriate clinical decision-making and consistent application of medical necessity criteria.
  • Develops and monitors UM performance dashboards including denial rates overturn rates length of stay and turnaround times.
  • Drives medical expense management initiatives by identifying utilization trends and implementing targeted interventions.
  • Collaborates with Case Management leadership to ensure seamless transitions between UM and care coordination functions.
  • Partners with pharmacy leadership to align utilization controls on high-cost drugs and specialty therapies.
  • Oversees hospital utilization management including inpatient admission appropriateness DRG optimization and reduction strategies.
  • Identifies and implements process improvement initiatives to increase operational efficiency and reduce variability.
  • Prepares for a lead regulatory audits accreditation reviews and corrective action plans related to UM functions.
  • Monitors and ensures compliance with evidence-based clinical criteria tools (e.g. InterQual ASAM) and internal policies.
  • Leads workforce planning and staffing models to ensure appropriate caseload distribution and productivity standards.
  • Supervises and develops UM managers and supervisors including performance evaluations and professional development.
  • Collaborates with Finance and Actuarial team to analyze utilization trends cost drivers and forecast medical expense impact.
  • Supports value-based payment models and alternative payment initiatives by aligning UM process with performance metrics.
  • Develops escalation and peer review process to manage complex or high-risk clinical determinations.
  • Ensures culturally competent and member- center decision-making balancing access quality and cost stewardship.
  • Provides executive-level reporting and strategic recommendation to the VP of Clinical Operations and senior leadership
    • Minimal Qualifications
    Education
    • Bachelor's degree Bachelor's degree in Nursing Social Work or related healthcare field required
    • Master's degree Master's degree in Nursing (MSN) Public Health (MPH) Healthcare Administration (MHA) Business Administration (MBA) or related field preferred
    Experience
    • 8-10 years years of managed care experience required and
    • 5-7 years Minimum 5 years utilization management leadership required and
    • Experience with centralized operations preferred and
    • Demonstrated experience in Medicaid managed care preferred
    Licenses and Certifications
    • RN - Registered Nurse - State Licensure and/or Compact State Licensure in MD/DC Upon Hire required
    Knowledge Skills and Abilities
    • Deep understanding of state Medicaid CMS and NCQA requirements
    • Experience in medical necessity criteria tools (InterQual)
    • Strong data analytics and financial acumen
    • Change management expertise
    • Excellent executive communication skills.

    This position has a hiring range of
    USD $120,702.00 - USD $238,222.00 /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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