Utilization Management
Reston, VA · Remote
Utilization Management Location: Reston, VA (Remote) Duration: 3+ Months Contract PURPOSE: Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and ...
Reston, VA · Remote
Utilization Management Location: Reston, VA (Remote) Duration: 3+ Months Contract PURPOSE: Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and ...
Reston, VA · Remote
Utilization Management Location: Reston, VA (Remote) Duration: 3+ Months Contract PURPOSE: Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and ...
Visit us online: www.thehughescenter.com The Director of Utilization Management assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when ...
Visit us online: www.thehughescenter.com The Director of Utilization Management assists admissions in screening patients at the pre-hospital level to ensure that admission criteria are met, and when ...
Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and ...
Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and ...
Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and ...
Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and ...
Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and ...
Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and ...
Roanoke, VA · On-site
$15.75 - $21.25/hr
Utilization Management Representative I Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions ...
Roanoke, VA · On-site
$15.75 - $21.25/hr
Utilization Management Representative I Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions ...
Richmond, VA · On-site
$15.75 - $21.50/hr
Utilization Management Representative I Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions ...
Richmond, VA · On-site
$15.75 - $21.50/hr
Utilization Management Representative I Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions ...
Norfolk, VA · On-site
$15.50 - $21/hr
Utilization Management Representative I Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions ...
Norfolk, VA · On-site
$15.50 - $21/hr
Utilization Management Representative I Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions ...
Williamsburg, VA · On-site
Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization ...
Williamsburg, VA · On-site
Coordinates, performs, and monitors all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization ...
... management of onsite and remote staff up to 12 direct reports and oversight up to 50) Call Center experience preferred Utilization Manager experience preferred Previous Managed Care experience ...
... management of onsite and remote staff up to 12 direct reports and oversight up to 50) Call Center experience preferred Utilization Manager experience preferred Previous Managed Care experience ...
... management of onsite and remote staff up to 12 direct reports and oversight up to 50) Call Center experience preferred Utilization Manager experience preferred Previous Managed Care experience ...
... management of onsite and remote staff up to 12 direct reports and oversight up to 50) Call Center experience preferred Utilization Manager experience preferred Previous Managed Care experience ...
Richmond, VA · On-site
$16.75 - $20/hr
Utilization Management Representative II - Benefit Investigation Utilization Management Representative II - Benefit Investigation Virtual: This role enables associates to work virtually full-time, ...
Richmond, VA · On-site
$16.75 - $20/hr
Utilization Management Representative II - Benefit Investigation Utilization Management Representative II - Benefit Investigation Virtual: This role enables associates to work virtually full-time, ...
In this position, you will ensure all utilization management and training processes are completed as needed to ensure quality services are provided. While working for NRVCS, you are subject to our ...
In this position, you will ensure all utilization management and training processes are completed as needed to ensure quality services are provided. While working for NRVCS, you are subject to our ...
In this position, you will ensure all utilization management and training processes are completed as needed to ensure quality services are provided. While working for NRVCS, you are subject to our ...
In this position, you will ensure all utilization management and training processes are completed as needed to ensure quality services are provided. While working for NRVCS, you are subject to our ...
Performs a variety of utilization and resource management activities to promote quality, clinical and cost-effective outcomes. Assesses patients treatment plans, communicates to third party payers ...
Performs a variety of utilization and resource management activities to promote quality, clinical and cost-effective outcomes. Assesses patients treatment plans, communicates to third party payers ...
Saratoga Medical is hiring for a Clinical Nurse, Medical Management/Utilization Management in Falls Church, Virginia. Package includes competitive rate, paid time off and benefit options. This is a ...
Saratoga Medical is hiring for a Clinical Nurse, Medical Management/Utilization Management in Falls Church, Virginia. Package includes competitive rate, paid time off and benefit options. This is a ...
Saratoga Medical is hiring for a Clinical Nurse, Medical Management/Utilization Management in Falls Church, Virginia. Package includes competitive rate, paid time off and benefit options. This is a ...
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Saratoga Medical is hiring for a Clinical Nurse, Medical Management/Utilization Management in Falls Church, Virginia. Package includes competitive rate, paid time off and benefit options. This is a ...
... utilization management activities; and assists with risk management functions.
... utilization management activities; and assists with risk management functions.
First line supervisor in the Utilization Management Department. Facilitates the work of assigned team members. Provides a leadership role in ongoing utilization review competency assessment, needs ...
First line supervisor in the Utilization Management Department. Facilitates the work of assigned team members. Provides a leadership role in ongoing utilization review competency assessment, needs ...
First line supervisor in the Utilization Management Department. Facilitates the work of assigned team members. Provides a leadership role in ongoing utilization review competency assessment, needs ...
First line supervisor in the Utilization Management Department. Facilitates the work of assigned team members. Provides a leadership role in ongoing utilization review competency assessment, needs ...
$38.7K - $49.8K
15% of jobs
$49.8K - $61K
8% of jobs
$62.6K is the 25th percentile. Wages below this are outliers.
$61K - $72.2K
15% of jobs
The median wage is $79.3K / yr.
$72.2K - $83.4K
20% of jobs
$83.4K - $94.5K
11% of jobs
$100.1K is the 75th percentile. Wages above this are outliers.
$94.5K - $105.7K
13% of jobs
$105.7K - $116.9K
5% of jobs
$116.9K - $128.1K
3% of jobs
$128.1K - $139.3K
4% of jobs
$139.3K - $150.4K
3% of jobs
$150.4K - $161.6K
3% of jobs
$38.7K
$88.7K
$161.6K
To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.
A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.
As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

Job Title: Utilization Management
Location: Reston, VA (Remote)
Duration: 3+ Months Contract
PURPOSE:
Supports the Utilization Management clinical teams by assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review, care coordination and quality of care.
3 years’ experience in health care/managed care setting or previous work experience within division
2 years of CPT and ICD-10 coding.
Previous authorization experience
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It services
1,001 - 5,000 Employees
Atlanta, GA, US
1994