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Utilization Care Manager Jobs in Washington (NOW HIRING)

V-Tech Solutions Inc.

RN Care Manager

Washington, DC · Remote

$36.32 - $46/hr

Identify gaps in care and address over- or under-utilization of services * Document care management activities accurately and timely per policy Education & Experience * Associate's Degree in Nursing ...

V-Tech Solutions

RN Care Manager

Washington, DC · On-site

$36.32 - $46/hr

Identify gaps in care and address over- or under-utilization of services * Document care management activities accurately and timely per policy Education & Experience * Associate's Degree in Nursing ...

V-Tech Solutions Inc.

RN Care Manager

Washington, DC · On-site

$36.32 - $46/hr

Identify gaps in care and address over- or under-utilization of services * Document care management activities accurately and timely per policy Education & Experience * Associate's Degree in Nursing ...

Hscsnhealthplan

HSCSN RN Care Manager

Washington, DC · On-site

$77.58 - $129.29/hr

Minimum Work Experience** 2 years Clinically related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review, Disease Management or Managed Care (Required) 1 ...

Luminis Health

Utilization Management Nurse

Lanham, MD

$34 - $55/hr

Monitors and identifies patterns or trends in utilization management; monitors potential and actual ... Collaborates with the Care Coordinator to achieve optimal and efficient patient outcomes while ...

Luminis Health

Utilization Management Nurse

Annapolis, MD · On-site

$34 - $55/hr

Monitors and identifies patterns or trends in utilization management; monitors potential and actual ... Collaborates with the Care Coordinator to achieve optimal and efficient patient outcomes while ...

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Utilization Care Manager information

What is a utilization care manager?

Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.

How does a utilization care manager collaborate with medical and administrative teams to ensure effective patient care?

Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.

What are the key skills and qualifications needed to thrive as a utilization care manager, and why are they important?

To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.

What is the difference between Utilization Care Manager vs Utilization Review Nurse?

AspectUtilization Care ManagerUtilization Review Nurse
CredentialsRN, case management certificationRN, certification in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing resourcesReviewing medical necessity, approving treatments

Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What does a utilization care manager do in healthcare?

A utilization care manager in healthcare reviews patient cases to ensure appropriate use of medical services and resources, coordinating care plans to optimize patient outcomes and reduce unnecessary costs. They often work with healthcare providers, insurance companies, and patients, using data and clinical guidelines to make informed decisions about treatment and service utilization.

What are popular job titles related to Utilization Care Manager jobs in Washington?

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

What job categories do people searching Utilization Care Manager jobs in Washington look for?

The top searched job categories for Utilization Care Manager jobs in Washington are:

What cities in Washington are hiring for Utilization Care Manager jobs?

Cities in Washington with the most Utilization Care Manager job openings:

Utilization Care Manager jobs near you

Manager, Care Manager

Maryland Care Management Inc

Linthicum, MD • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 10 hours ago

Job description

Description

Summary/Position Objectives:

This position is responsible for oversight of the planning, development, implementation, and evaluation of Care Management (CM) programs. The Manager of CM is responsible for ensuring staff follow the care management process as defined by improving coordination, continuity, accessibility, and appropriate utilization of healthcare services and community resources for high-risk and special needs members, improving health outcomes and engagement in health seeking behaviors. 


About Maryland Care Management, Inc. (MCMI)

Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest Medicaid-managed care organizations.


Why join us?

MCMI recognizes the importance of flexibility and offers multiple work arrangements. Along with competitive pay, we offer excellent benefits (medical, dental, and vision plans, 100% employer Term Life Insurance, Short and Long-Term Disability, 401k Employer Match up to 4%) as well as 20 days of PTO, and tuition assistance/professional development plans. 

Your future colleagues at MCMI are welcoming, friendly, and eager to help each other succeed. We are committed to Diversity, Equity, and Inclusion, providing organizational-wide social opportunities, and constantly improving our ongoing efforts to positively impact our members' lives.


What You'll Do: 

  • Provide oversight of care management programs.
  • Responsible for recruitment and selection of appropriate staff and prepares for timely employee performance evaluations.
  • Promote individual and team development and provide performance management, when necessary.
  • Prepare reports on key indicators and activities for committees and senior management.
  • Collaborate with the Director of CM on development of annual budget and operates within approved budget.
  • Collaborate with interdisciplinary teams to support staff in coordination of care activities.
  • Serves as a resource for health plan information and helps to integrate care management functions throughout the health plan.
  • Assists in the annual development of measurable goals for care management programs based on data from outcomes reports, quality indicators, regulatory agencies, and health plan initiatives and priorities.
  • Implement ongoing development and education of care management staff.
  • Ensures that program integrity and regulatory requirements are met in conjunction with the Director of CM.
  • Other duties as assigned. 

Secondary Functions:

  • Communicates regularly with employees through staff meetings to share company, health plan, and department information appropriate to their job function.
  • Maintains and promotes patient confidentiality and adheres to HIPAA regulations.
  • Responsible for development, implementation, and annual review of care management policies and desktops.

Requirements

Knowledge and Skills:

  • Demonstrated skills for presentations and training before small and large groups.
  • Knowledge of local health care delivery system.
  • Strong problem solving, organizational, and time management skills with the ability to work in a fast-paced environment.
  • The ability to successfully utilize Microsoft Office suite and common computer and office hardware is necessary.

Education and Work Experience:

  • Current state RN license required. 
  • Bachelor of Science in Nursing (BSN) preferred.
  • Minimum of two years of management/supervisory experience required. 
  • Minimum of three years of care management experience required.
  • CCM Certification preferred.
  • Managed Care experience is preferred.

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