Arlington, VA · On-site
$368K - $460K/yr
As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy ...
Arlington, VA · On-site
$368K - $460K/yr
As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy ...
As a FMD, Radiology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can ...
As a FMD, Radiology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can ...
Arlington, VA · On-site
$368K - $460K/yr
As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy ...
Arlington, VA · On-site
$368K - $460K/yr
As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy ...
Focus on utilization management (UM), compliance, and clinical documentation improvement (CDI) to support hospital performance. * Dedicated site coordinator helps maintain a healthy work-life balance.
Focus on utilization management (UM), compliance, and clinical documentation improvement (CDI) to support hospital performance. * Dedicated site coordinator helps maintain a healthy work-life balance.
Washington, DC · On-site
$85K/yr
We are seeking master's level, licensed, clinician, with documented experience in utilization review, management, and quality assurance skills! Are you ready and willing to make a difference and ...
New
Washington, DC · On-site
$85K/yr
We are seeking master's level, licensed, clinician, with documented experience in utilization review, management, and quality assurance skills! Are you ready and willing to make a difference and ...
New
Washington, DC · On-site
$85K/yr
We are seeking master's level, licensed, clinician, with documented experience in utilization review, management, and quality assurance skills! Are you ready and willing to make a difference and ...
Washington, DC · On-site
$85K/yr
We are seeking master's level, licensed, clinician, with documented experience in utilization review, management, and quality assurance skills! Are you ready and willing to make a difference and ...
Washington, DC · On-site
$130 - $140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
Washington, DC · On-site
$130 - $140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
We focus on utilization management (UM), compliance, and clinical documentation improvement (CDI) to support hospital performance. * Our dedicated site coordinator will help maintain a healthy work ...
We focus on utilization management (UM), compliance, and clinical documentation improvement (CDI) to support hospital performance. * Our dedicated site coordinator will help maintain a healthy work ...
We focus on utilization management (UM), compliance, and clinical documentation improvement (CDI) to support hospital performance. * Our dedicated site coordinator will help maintain a healthy work ...
We focus on utilization management (UM), compliance, and clinical documentation improvement (CDI) to support hospital performance. * Our dedicated site coordinator will help maintain a healthy work ...
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
Washington, DC · On-site
$33.60 - $50.40/hr
Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...
Washington, DC · On-site
$33.60 - $50.40/hr
Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...
Network Partner quarterly meetings, Utilization Management roundtables) * Lead activities around Hill Days, meetings with Congressional staff, and other offerings * Lead and manage activities around ...
Network Partner quarterly meetings, Utilization Management roundtables) * Lead activities around Hill Days, meetings with Congressional staff, and other offerings * Lead and manage activities around ...
... management plans; training and mentoring performance; and driving process improvements. As a Technical Infrastructure Program Manager within this team focused on global data center inventory and ...
... management plans; training and mentoring performance; and driving process improvements. As a Technical Infrastructure Program Manager within this team focused on global data center inventory and ...
Washington, DC · On-site
$120K - $132K/yr
Network Partner quarterly meetings, Utilization Management roundtables) * Lead activities around Hill Days, meetings with Congressional staff, and other offerings * Lead and manage activities around ...
Washington, DC · On-site
$120K - $132K/yr
Network Partner quarterly meetings, Utilization Management roundtables) * Lead activities around Hill Days, meetings with Congressional staff, and other offerings * Lead and manage activities around ...
Washington, DC · On-site
$120K - $132K/yr
Network Partner quarterly meetings, Utilization Management roundtables) * Lead activities around Hill Days, meetings with Congressional staff, and other offerings * Lead and manage activities around ...
Quick apply
Washington, DC · On-site
$120K - $132K/yr
Network Partner quarterly meetings, Utilization Management roundtables) * Lead activities around Hill Days, meetings with Congressional staff, and other offerings * Lead and manage activities around ...
Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...
Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...
Washington, DC · On-site
$120 - $180/hr
Network Partner quarterly meetings, Utilization Management roundtables) * Lead activities around Hill Days, meetings with Congressional staff, and other offerings * Lead and manage activities around ...
Washington, DC · On-site
$120 - $180/hr
Network Partner quarterly meetings, Utilization Management roundtables) * Lead activities around Hill Days, meetings with Congressional staff, and other offerings * Lead and manage activities around ...
Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...
Informs department director of changes in managed care companies. Maintains awareness of unique ... Six months psychiatric utilization review either for hospital or external review organization ...
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 ...
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 ...
... management plans; training and mentoring performance; and driving process improvements. As a Technical Infrastructure Program Manager within this team focused on global data center inventory and ...
... management plans; training and mentoring performance; and driving process improvements. As a Technical Infrastructure Program Manager within this team focused on global data center inventory and ...
$40.6K - $52.4K
15% of jobs
$52.4K - $64.1K
8% of jobs
$65.8K is the 25th percentile. Wages below this are outliers.
$64.1K - $75.9K
15% of jobs
The median wage is $83.3K / yr.
$75.9K - $87.6K
20% of jobs
$87.6K - $99.4K
11% of jobs
$105.3K is the 75th percentile. Wages above this are outliers.
$99.4K - $111.1K
13% of jobs
$111.1K - $122.9K
5% of jobs
$122.9K - $134.6K
3% of jobs
$134.6K - $146.4K
4% of jobs
$146.4K - $158.1K
3% of jobs
$158.1K - $169.9K
3% of jobs
$40.6K
$93.3K
$169.9K
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.
The most popular types of Utilization Management jobs in Reston, VA are:
For Utilization Management jobs in Reston, VA, the most frequently searched job titles are:
The top searched job categories for Utilization Management jobs in Reston, VA are:
Cities near Reston, VA with the most Utilization Management job openings:
8.4
Based on 18 frontline employees who took The Breakroom Quiz
69th of 491 rated business services
As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes.
Collaboration Opportunities:
Routinely interacts with leadership and management staff, other Physicians, and staff whenever a physician s input is needed or required.
What You Will Be Doing:
Serve as the Physician match reviewer in Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests when providers, clients, or state laws require specialty reviews to be completed by the subject matter expert.
Discusses determinations (peer to peer phone calls) with requesting physicians or ordering providers, when available, within the regulatory timeframe of the request and provides clinical rationale for standard and expedited appeals.
Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance (NCQA) guidelines.
Aids and acts as a resource to Initial Clinical Reviewers.
Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely and accurate manner.
May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support.
Participates in on-going training per inter-rater reliability process.
Qualifications:
MD/DO/MBBS
Minimum of five (5) years experience in the practice of Medicine, post residency and Active Clinical practice within the last 2 years is preferred
Current, unrestricted clinical license in home state medicine or required specialty-
Obtaining and maintaining medical licenses in the state you reside, as well as, any license required per business needs
Active Board Certification by an accredited organization
Strong clinical, management, communication, and organizational skills
Energetic and curious with a passion for quality and value in health care
Computer Proficiency
Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an excluded person by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare.
No history of a major disciplinary or legal action by a state medical board
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Health care and social assistance
1,001 - 5,000 Employees
Arlington, VA, US
