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Utilization Management Jobs in Reston, VA (NOW HIRING)

Compass Group

SPACE UTILIZATION COORDINATOR

Mclean, VA · On-site

$55K - $62K/yr

As the Space Utilization Coordinator, you'll oversee meeting space reservations, ensuring optimal ... Manage and assign meeting spaces based on availability and event needs. * Audit reservations to ...

Lucyrx

Clinical Strategy Pharmacist

Bethesda, MD · On-site +1

$126K - $151K/yr

Lead formulary strategy development, including formulary design, tiering, utilization management approaches, and preferred drug strategies across therapeutic classes * Evaluate clinical evidence ...

Addison Group

HSCPC RN Case Manager

Washington, DC · On-site

$80K - $115K/yr

This role will oversee daily operations within a highly collaborative, multidisciplinary clinical resource management team focused on patient throughput, utilization management, intake coordination ...

Trinity Health

Physician Advisor

Silver Spring, MD · On-site

$98.65 - $147.98/hr

The Physician Advisor provides expertise related to appropriate utilization/level of care (LOC), length of stay (LOS) management, patient flow/throughput management, appropriate clinical ...

Trinityhealth

Physician Advisor

Silver Spring, MD

$98.65 - $147.98/hr

The Physician Advisor provides expertise related to appropriate utilization/level of care (LOC), length of stay (LOS) management, patient flow/throughput management, appropriate clinical ...

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All JobsUtilization Management JobsUtilization Management Jobs in Reston, VA

Utilization Management information

See Reston, VA salary details

$40.6K

$93.3K

$169.9K

How much do utilization management jobs pay per year?

As of Jul 23, 2026, the average yearly pay for utilization management in Reston, VA is $93,253.00, according to ZipRecruiter salary data. Most workers in this role earn between $67,200.00 and $108,900.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Utilization Management position, 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 is a Utilization Management job?

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 most commonly searched types of Utilization Management jobs in Reston, VA? The most popular types of Utilization Management jobs in Reston, VA are:
What are popular job titles related to Utilization Management jobs in Reston, VA? For Utilization Management jobs in Reston, VA, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Reston, VA look for? The top searched job categories for Utilization Management jobs in Reston, VA are:
What cities near Reston, VA are hiring for Utilization Management jobs? Cities near Reston, VA with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Reston, VA as of July 2026, with employment types broken down into 1% As Needed, 82% Full Time, 13% Part Time, 1% Temporary, and 3% Contract. Highlights an 93% Physical, 2% Hybrid, and 5% Remote job distribution, with an average salary of $93,253 per year, or $44.8 per hour.

Quality Assurance and Utilization Review Manager

ASPEN OF DC INC

Washington, DC • On-site

$33.65/hr

Other

Posted 11 days ago

Job description

Provides clinical, operational, and quality assurance leadership in the coordination and oversight of healthcare and transportation-related services. Ensures compliance with regulatory, contractual, and organizational standards through utilization review, quality assurance activities, risk management, staff training, and continuous process improvement. Serves as a clinical subject matter expert and liaison to medical facilities, community organizations, and internal teams while promoting high-quality customer service and operational excellence.
Essential Functions:
Clinical & Operational Oversight
• Performs thorough review of assessments, diagnoses, and service requests to determine appropriateness of care and transportation services.
• Coordinates service delivery and monitors service-related issues to ensure continuity of care, program compliance, and customer satisfaction.
• Identifies risks, implements safety plans, and collaborates with interdisciplinary teams to address clinical and operational concerns.
• Serves as a representative to medical facilities and community partners regarding healthcare and transportation services.
Quality Assurance & Compliance
• Plans, coordinates, and directs quality assurance and utilization review activities to ensure compliance with company policies, contractual requirements, and regulatory standards.
• Conducts audits, analyzes quality data, and applies process improvement methods to enhance operational performance.
• Maintains knowledge of healthcare regulations, accreditation standards, and quality assurance requirements.
• Investigates customer complaints and develops corrective action plans to improve service quality.
• Supports accreditation initiatives and organizational compliance programs.
Education & Community Relations
• Develops and facilitates training, outreach, and in-service programs for staff, healthcare providers, and community organizations.
• Builds and maintains relationships with healthcare facilities, community agencies, and stakeholders.
• Provides presentations and educational resources related to healthcare services, quality standards, and transportation coordination.
Administrative & Leadership Responsibilities
• Keeps leadership informed of significant operational, quality, compliance, and customer service issues.
• Supervises and supports staff involved in quality assurance, utilization review, and service coordination activities.
• Assists with development and implementation of policies, procedures, and continuous improvement initiatives.
• Performs additional duties as assigned.
QUALIFICATIONS REQUIRED
• Registered Nurse (RN) degree required.
• Minimum three (3) years of clinical nursing experience with direct patient care experience preferred.
• Experience in utilization review, quality assurance, healthcare compliance, or managed care environment preferred.
• Knowledge of Medicare, Medicaid, community resources, dialysis, and nursing home placement processes.
• Strong understanding of quality assurance principles, regulatory compliance, and process improvement methods.
• Demonstrated leadership, organizational, and problem-solving skills.
• Excellent written, verbal, interpersonal, and customer service communication skills.
• Ability to work effectively within interdisciplinary teams and manage multiple priorities in a fast-paced environment.
• Proficiency in Microsoft Office Suite, including Word and Excel.
• Ability to maintain confidentiality and handle sensitive information professionally.
• Flexible, self-directed, and able to work independently or collaboratively within a team environment.

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