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Utilization Management Jobs in Washington, DC (NOW HIRING)

Amerihealth Caritas

UM Technician

Washington, DC · On-site +1

$27.02 - $36.78/hr

The Utilization Management Technician functions under the direction of the Supervisor to coordinate, generate and track both incoming and outgoing correspondence, faxes and authorizations related to ...

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Utilization Management information

See Washington, DC salary details

$44.2K

$101.3K

$184.6K

How much do utilization management jobs pay per year?

As of Sep 6, 2026, the average yearly pay for utilization management in Washington, DC 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 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 Washington, DC?

The most popular types of Utilization Management jobs in Washington, DC are:

What are popular job titles related to Utilization Management jobs in Washington, DC?

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

What job categories do people searching Utilization Management jobs in Washington, DC look for?

The top searched job categories for Utilization Management jobs in Washington, DC are:

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Washington, DC as of August 2026, with employment types broken down into 100% Full Time. Highlights an 86% In-person, and 14% Remote job distribution, with an average salary of $101,348 per year, or $48.7 per hour.

Utilization Management Coordinator

University of Maryland Medical System

Glen Burnie, MD • On-site

$386K/yr

Full-time

Posted 8 days ago

Job description

Job Requirements
Under general supervision, provides utilization review and denials management for an assigned patient case load. This role utilizes nationally recognized care guidelines/criteria to assess the patient's need for outpatient or inpatient care as well as the appropriate level of care. The role requires interfacing with the case managers, medical team, other hospital staff, physician advisors and payers.
Work Experience
The following statements are intended to describe the general nature and level of work being performed by staff assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.
1. Performs timely and accurate utilization review for all patient populations, using nationally recognized care guidelines/criteria relevant to the payer.
2. Communicates with case manager, physician advisor, medical team and payors as needed regarding reviews and pended/denied days and interventions.
3. Supports concurrent appeals process through proactive identification of pended/denied days. Implements the concurrent appeals process with appropriate referrals and documentation.
4. Ensures appropriate Level of Care and patient status for each patient (Observation, Extended Recovery, Administrative, Inpatient, Critical Care, Intermediate Care, and Med-Surg)
5. Reviews tests, procedures and consultations for appropriate utilization of resources in a timely manner
Education and Experience
1. Licensure as a Registered Nurse or other equivalent health care license in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required.
Knowledge, Skills and Abilities
1. Knowledge of utilization management is preferred.
2. Highly effective verbal and written skills are required.
3. Strong communication skills, self-confidence and experience in working with physicians are required.
4. Excellent analytical and team building skills, as well as the ability to prioritize and work independently are required.
5. The ability to work collaboratively with other disciplines is required.
6. Ability to work with Hospital/ Utilization Management and related software programs is required.
6. HINN discussions/Observation Education
7. Assists Case Manager in Avoidable Days Collection
8. Ownership of Regulatory Compliance related to Utilization Management conditions of participation
9. Assures appropriate reimbursement and stewardship of organizational and patient resources.
10. Actively reports opportunities to improve reimbursement and responds to relevant data
11. Collaborates with admitting specialists regarding authorization policies and procedures of third party payers.
12. Remains current on clinical practice and protocols impacting clinical reimbursement

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