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Utilization Care Manager Jobs in Reston, VA (NOW HIRING)

V-Tech Solutions Inc.

RN Care Manager

Washington, DC ยท 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 Inc.

RN Care Manager

Washington, DC ยท 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 ...

Volunteers of America

Clinical Care Manager

Lanham, MD ยท On-site

$101K - $134K/yr

Is accountable for meeting organizational and participant outcomes and utilization goals. Required ... care settings. * Provides oversight, management, and direction of the overall operational ...

Elevance Health

Nurse Case Mgr Sr

Washington, DC

$83.75K - $137.59K/yr

Assists with development of utilization/care management policies and procedures, chairs, and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and ...

Elevance Health

Nurse Case Mgr Sr

Washington, DC ยท On-site

$83.75K - $137.59K/yr

Assists with development of utilization/care management policies and procedures, chairs, and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and ...

Elevance Health

Nurse Case Mgr Sr

Washington, DC

$83.75K - $137.59K/yr

Assists with development of utilization/care management policies and procedures, chairs, and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and ...

Elevance Health

Nurse Case Mgr Sr

Ashburn, VA ยท On-site

$83.75K - $137.59K/yr

Assists with development of utilization/care management policies and procedures, chairs, and schedules meetings, as well as presents cases for discussion at Grand Rounds/Care Conferences and ...

MedStar Health

RN Utilization Mgmt

Washington, DC ยท On-site

$89.07K - $162.80K/yr

About the Job General Summary of Position The RN Utilization Manager will have 1-2 years of ... Responsible for clinical review of acute care services based on Medically Necessity criteria the ...

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Utilization Care Manager information

See Reston, VA salary details

$40.6K

$94.7K

$174.3K

How much do utilization care manager jobs pay per year?

As of Jun 1, 2026, the average yearly pay for utilization care manager in Reston, VA is $94,684.00, according to ZipRecruiter salary data. Most workers in this role earn between $61,900.00 and $113,900.00 per year, depending on experience, location, and employer.

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.

How does a Utilization Care Manager typically 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 Utilization Care Managers?

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.

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 job categories do people searching Utilization Care Manager jobs in Reston, VA look for? The top searched job categories for Utilization Care Manager jobs in Reston, VA are:
What cities near Reston, VA are hiring for Utilization Care Manager jobs? Cities near Reston, VA with the most Utilization Care Manager job openings:
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