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Utilization Management Nurse Jobs in Washington (NOW HIRING)

MedStar Health

RN Team Lead Utilization Review

Clinton, MD · On-site

$89K - $162K/yr

Manages daily assignment ensuring all UM tasks are completed each day. Collaborates with the ... utilization of resources. Minimal Qualifications Education * Bachelor's degree in Nursing required ...

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Utilization Management Nurse information

See Washington salary details

$44.2K

$101.3K

$184.6K

How much do utilization management nurse jobs pay per year?

As of Sep 2, 2026, the average yearly pay for utilization management nurse 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 is a utilization management nurse?

A Utilization Management Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients. They review medical records and treatment plans to ensure that care meets established guidelines and is cost-effective. Utilization Management Nurses work with healthcare providers, insurance companies, and patients to coordinate care and prevent unnecessary procedures or hospitalizations. Their goal is to support high-quality patient care while managing healthcare costs.

What does a utilization management nurse do?

A utilization management nurse ensures that healthcare services are administered appropriately. Their job responsibilities include working in a hospital, health practice, or other clinical setting reviewing patient clinical records, drafting clinical appeals, and overseeing staff members. The qualifications for a utilization management nurse include a nursing degree and a registered nursing license. Most people in this job also have career experience in case management and utilization review.

What are the key skills and qualifications needed to thrive as a utilization management nurse?

To thrive as a Utilization Management Nurse, you need a registered nursing license, strong clinical judgment, and experience in case management or utilization review. Familiarity with medical management software, InterQual or Milliman guidelines, and insurance authorization processes is typically required. Excellent analytical thinking, communication, and negotiation skills help you coordinate with providers and advocate for patients. These competencies ensure appropriate resource use, compliance with regulations, and optimal patient outcomes.

What are some common challenges a utilization management nurse faces when coordinating care between providers and insurance companies?

A Utilization Management Nurse often navigates the challenge of balancing patient advocacy with insurance guidelines, ensuring that care recommendations meet both clinical standards and payer requirements. Communicating complex medical information to both providers and insurance representatives can be demanding, especially when there are disagreements about coverage or medical necessity. Additionally, staying updated on changing policies and maintaining thorough documentation under tight deadlines are frequent aspects of the role. Strong collaboration skills and attention to detail are essential for success in this position.

What is the difference between Utilization Management Nurse vs Case Manager?

AspectUtilization Management NurseCase Manager
CredentialsRN license, certifications in utilization reviewRN license, case management certification often preferred
Work EnvironmentInsurance companies, healthcare organizations, utilization review departmentsHospitals, community health agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning

Utilization Management Nurses primarily focus on reviewing medical necessity and approving healthcare services, while Case Managers coordinate patient care and facilitate discharge planning. Both roles require RN licensure and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

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For Utilization Management Nurse jobs in Washington, the most frequently searched job titles are:

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Utilization Management Nurse jobs near you
Infographic showing various Utilization Management Nurse job openings in Washington as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $101,348 per year, or $48.7 per hour.

Registered Nurse - Utilization Management

Spectrum Healthcare Resources

Camp Springs, MD • On-site

Other

Re-posted 10 days ago

Job description


Spectrum Healthcare Resources has an opportunity for a Registered Nurse Utilization Management (UMRN) working at Joint Base Andrews in Washington, D.C.
Requirements:
  • Associates Degree of Nursing
  • Current, full, active, and unrestricted license to practice as a Registered Nurse (Any State)
  • Must have at least 36 months of total nursing experience in direct patient care clinical setting. Must have utilization management, utilization review or case management experience for 24 recent consecutive months
  • Certified/certification eligible in relevant specialty, such as Certified Managed Care Nurse through the American Board of Managed Care Nurses, or Certified Informatics Nursing, Ambulatory Care Nursing, Medical-Surgical Nursing, or Nursing Case Management through the American Nurses Credentialing Center.
  • Highly organized, self-directed worker able to function in a high-volume environment without distractions.
  • Strong verbal and written communication skills.
  • Proficient level of experience with Microsoft Office applications and strong technical aptitude.

Work Schedule:
  • Monday - Friday
  • No nights and weekends
  • 8 hours a day

Company Overview:
Spectrum Healthcare Resources (SHR) was established in 1988 to deliver systems and processes designed to meet the unique needs of Military and VA Health Systems. SHR is a leading organization that provides physician and clinical staffing and management services to United States Military Treatment Facilities, VA clinics and other Federal Agencies through various contracting vehicles. A Joint Commission Health Care Staffing Services firm, SHR is the military staffing division of TeamHealth, a Nationwide organization that serves 850 civilian and military hospitals with a team of 9,600 affiliated health care professionals.
EOE/Disabled/Veterans
Joseph Day
Recruiter
Direct: (314) 744-4138
424 S Woods Mill Rd | Suite 205 | Town & Country, MO 63017
Location : Location
US-MD-Camp Springs
Recruiter : Full Name: First Last
Joseph Day
Direct phone number
314-744-4138
Recruiter : Email
joseph_day@spectrumhealth.com
Spectrum Healthcare Resources logo

About Spectrum Healthcare Resources

Sourced by ZipRecruiter

Spectrum is a leading organization that provides program management and physician and clinical staffing services to United States Military Treatment Facilities, VA Clinics and Federal Agencies. We are dedicated to the markets we serve, leading our organization’s experience for almost three decades.

Industry

Health care and social assistance

Company size

1,001 - 5,000 Employees

Headquarters location

Saint Louis, MO, US

Year founded

1988

Social media

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