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Utilization Management Jobs in Washington, DC (NOW HIRING)

Summit BHC

Utilization Assistant - Acute

Annapolis, MD · On-site

The Utilization Assistant provides support to all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of ...

New

Amerihealth Caritas

Clinical Care Reviewer UM

Washington, DC · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Role Overview Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient services, ensuring treatment aligns with clinical ...

AmeriHealth Caritas

Clinical Care Reviewer UM

Washington, DC · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Role Overview Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity for inpatient and outpatient services, ensuring treatment aligns with clinical ...

MedStar Health

Director Case Management

Columbia, MD · On-site

The Director of Case Management (DCM) oversees case management activities that may include behavioral health utilization management and care management functions and serves as a liaison to government ...

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Showing results 21-40

All JobsUtilization Management JobsUtilization Management Jobs in Washington, DC

Utilization Management information

See Washington, DC salary details

$44.2K

$101.4K

$184.6K

How much do utilization management jobs pay per year?

As of Aug 15, 2026, the average yearly pay for utilization management in Washington, DC is $101,356.00, 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 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 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 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 1% As Needed, 82% Full Time, 14% Part Time, and 3% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $101,356 per year, or $48.7 per hour.

Utilization Assistant - Acute

Summit BHC

Annapolis, MD • On-site

Other

Posted 3 days ago

New

Job description

Utilization Assistant - Acute | Highland Hospital | Annapolis, Maryland
About the Job:
The Utilization Assistant provides support to all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization review information. Works with insurance providers to obtain coverage for patients. Assists in utilization reviews and insurance appeals. Responds to inquiries from patients, their families, and professional referral sources.
Roles and Responsibilities:
• Assists the admissions department with pre-certifications of care. Performs pre and post admission benefit verification with managed care organizations.
• Reviews medical records of patients for appropriateness of level of care at admission and at intervals determined by documentation in medical record.
• Conducts interactive and timely reviews with payers to ensure certification of care.
• Maintains accurate documentation and files as it relates to utilization management.
• Coordinates information and findings with the business office to help recognize or resolve possible payment problems.
• Attends daily treatment team to discuss patient needs and ensure that all disciplines are aware of patient insurance status and needs.
• Ensure that insurance benefits are verified in a timely manner.
• Communicates any UR or Quality issues as noted in the chart to supervisor immediately to ensure timely resolution of problems.
• Responds to telephone and Internet inquires.
• Researches insurance company guidelines and uses admission and continuing stay criteria for coverage.
• High School Diploma Required, Bachelor's Degree in social work, behavioral or mental health, or other related health field preferred.
• One or more years of direct clinical experience in a psychiatric or mental health setting preferred.
Why Highland Hospital?Highland Hospital offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Highland Hospital is an EOE.
Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.

Summit BHC logo

About Summit BHC

Sourced by ZipRecruiter

Summit BHC, based in Franklin, TN, USA, is a recognized leader in the field of addiction treatment and behavioral health care services. The company operates a nationwide network of treatment centers aimed at caring for individuals battling substance abuse and mental health disorders. Summit BHC was established with the mission to provide high-quality, addiction treatment and behavioral health services to those in need throughout the United States. With compassion, dignity, and respect as their core values, they endeavor to instill hope during the journey to recovery and beyond.

Industry

Health care and social assistance

Company size

501 - 1,000 Employees

Headquarters location

Franklin, TN, US

Year founded

2013

Social media

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