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Utilization Management Jobs in Frederick, MD (NOW HIRING)

Bcbsa

Director, Trade Client Relations

Gaithersburg, MD · Remote

$155K - $175K/yr

Analytics Team - Collaborate on drug trends and utilization data to inform clinical policy decisions, medical policy and formulary compliance, drug share shift and utilization management strategies

Inova

Registered Nurse (RN) Case Manager 1

Leesburg, VA · On-site

Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities. * Discusses payer criteria and ...

Inova

Registered Nurse (RN) Case Manager 1

Leesburg, VA · On-site

$86K - $140K/yr

Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities. * Discusses payer criteria and ...

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Utilization Management information

See Frederick, MD salary details

$38.8K

$89K

$162.1K

How much do utilization management jobs pay per year?

As of Aug 25, 2026, the average yearly pay for utilization management in Frederick, MD is $88,970.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,100.00 and $103,900.00 per year, depending on experience, location, and employer.

What is utilization management?

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.

What are the typical daily responsibilities of a utilization management professional?

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.

What are the key skills and qualifications needed to thrive in utilization management, and why are they important?

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.

What degree is needed for utilization management?

Utilization management professionals typically need at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Some roles may require a master's degree or professional certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Experience in healthcare settings and knowledge of medical terminology and insurance processes are also important.

What are the most commonly searched types of Utilization Management jobs in Frederick, MD?

The most popular types of Utilization Management jobs in Frederick, MD are:

What are popular job titles related to Utilization Management jobs in Frederick, MD?

For Utilization Management jobs in Frederick, MD, the most frequently searched job titles are:

What job categories do people searching Utilization Management jobs in Frederick, MD look for?

The top searched job categories for Utilization Management jobs in Frederick, MD are:

What cities near Frederick, MD are hiring for Utilization Management jobs?

Cities near Frederick, MD with the most Utilization Management job openings:

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Frederick, MD as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 18% Part Time, and 2% Contract. Highlights an 82% Physical, 3% Hybrid, and 15% Remote job distribution, with an average salary of $88,970 per year, or $42.8 per hour.

Registered Nurse (RN) Case Manager - PRN

Leesburg, VA • On-site

Inova
Health Care and Social Assistance • 10K+ employees

7.5

Company rating: 7.5 out of 10

Based on 260 frontline employees who took The Breakroom Quiz

239th of 893 rated healthcare providers

People enjoy working here

Good employer

Recommended by students

Learn more about Inovaexternal

Other

Medical, Dental, Vision, PTO

This job post has expired today. Applications are no longer accepted.

Job description

Job Description
Job Description

Inova Loudoun Hospital is looking for a dedicated Registered Nurse Case Manager 1 to join the Case Management Team. This role will be PRN (3 night shifts per months)

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

  • Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
  • Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.
  • Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
  • Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
  • Work/Life Balance: offering paid time off, paid parental leave

Registered Nurse (RN) Case Manager 1 Job Responsibilities:

The RN Case Manager 1 provides discharge planning and continuity of care for assigned patients in acute and post-acute settings. Provides coordination of services and acts as key liaison between patients, families and interdisciplinary healthcare members. Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities. Responsible for the timely regulatory compliance and facilitation of precertification and payer authorization processes when indicated. Actively participates in clinical performance improvement activities.
Registered Nurse (RN) Case Manager 1 Job Responsibilities:

  • Collects delay and other data for specific performance and/or outcome indicators. Assists in the collection and reporting of resource and financial indicators including acute and post-acute case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals. Collects, analyzes and addresses variances from plans of care and care paths with physicians and/or other members of the healthcare team. Uses concurrent variance data to drive practice changes and positively impact outcomes. Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g. discharge planning, chronic disease planning).
  • Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently. Ensures safe care to patients by adhering to policies, procedures and standards within budgetary specifications including time management, supply management, productivity and accuracy of practice. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency. Supports department based goals which contribute to the success of the organization.
  • Provides discharge planning and continuity of care for assigned patients in the acute and post-acute setting. Initiates and facilitates referrals to clinics, home healthcare, hospice, SNF, acute rehab, LTAC, TCM, medical equipment and supplies as indicated. Collaborates with the interdisciplinary healthcare team, patients and families in the assessment and coordination of discharge planning needs, delivery of post-discharge planning needs, delivery of post-discharge services and transition of patients from hospitals to the discharge setting as well as ongoing care in the community. Documents relevant discharge planning information in medical records according to department standards and/or care management plans.
  • Collaborates/communicates with internal and external case managers. Understands pre-acute and post-acute resources. Provides coordination of services and acts as a key Liaison between patients, families and the interdisciplinary healthcare team members. Work closely with members of patients' healthcare teams to manage and coordinate all areas of patients' care. Works holistically to ensure that healthcare plans and discharge plans meet the physical, social and emotional needs of patients.
  • Provides educational resources and/or referrals to patients and patients' families to address identified needs such as social or financial. Acts as an advocate for patients to resolve barriers to care progression. Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities.
  • Discusses payer criteria and issues on a case by case basis with clinical staff and follows-up to resolve problems with payers as needed. Applies approved clinical criteria to monitor appropriateness of admissions, continued stays or post-acute setting appropriateness and documents findings based on department standards.
  • Identifies at risk populations by using approved screening tools and following established reporting procedures. Monitors LOS and ancillary resource use, depending on inpatient stay or outpatient program criteria, on an ongoing basis and takes actions to achieve continuous improvement efficiencies in both areas. Refers cases and issues appropriately to resolve barriers to care progression.
  • Participates in the assessment of patients' clinical and psychosocial needs through review of patient information, personal contact with patients/families and interdisciplinary healthcare team members. Communicates routinely with patients, families, interdisciplinary healthcare team members and other appropriate parties with regard to the status of patients' care plans and progress toward treatment goals, identification of concerns and/or problems, problem solving and assisting with conflict resolution when necessary. Works with the multidisciplinary team to address/resolve system problems impeding diagnostic or treatment progress. Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge. Ensures that all elements critical to patients' care plans have been communicated to the patients/families and members of the healthcare team.
  • Performs other duties as assigned.


Minimum Qualifications:

  • Certification: Basic Life Support
  • Licensure: Licensed or eligible for licensure in the Commonwealth of Virginia as a Registered Nurse or an active multi-state Registered Nurse license
  • Experience: 1 year of case management and/or clinical care experience
  • Education: Bachelor's Degree Nursing or Associate's Degree. If RN has an Associate's Degree, within 2 years of date of hire, they must meet with their nurse leader and conduct the following: 1.) Identify which accredited school they plan to attend 2.) Provide a written plan with anticipated BSN completion date 3.) Submit a review of transcripts from the school indicating the required pre-requisites and timeline for taking the courses 4.) Complete BSN within 5 years of start date.

Preferred Qualifications:

  • One (1) year of previous Inpatient (hospital) case management experience and case management discharge planning is highly preferred.
About Us

We are Inova, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 26,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare. Inova Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.

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