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Utilization Management Jobs in Washington, DC (NOW HIRING)

Humana

Compliance UM Nurse (Wed - Sun)

Annapolis, MD · On-site

Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...

Prime Time Healthcare

Utilization Review

Washington, DC · On-site

Now Hiring: RN Utilization Review - Washington, DC Are you a passionate RN professional looking for a new adventure? Prime Time Healthcare is seeking dynamic individuals like you to join our team in ...

UVA Health

Physician Advisor (Remote)

Manassas, VA · Remote

$250K - $350K/yr

Physician Advisor (Remote) Opportunity UVA Health is seeking an experienced Physician Advisor to provide physician leadership across Utilization Management (UM), Clinical Documentation Integrity (CDI ...

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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 14, 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.

Social Work Manager Case Management

MedStar Health

Washington, DC • On-site

$102K - $196K/yr

Full-time

Posted 19 days ago

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 239 frontline employees who took The Breakroom Quiz

130th of 887 rated healthcare providers

Job description

About the Job
General Summary of Position
MedStar Health is looking for a Social Work Manager, Case Management. The Social Work Manager, Case Management Reports and works under the direction of the Director of Case Management. Provides leadership for the case management team and oversees the Department's daily activities. Coordinates the department's case management/utilization functions to provide efficient and effective outcome-based patient centered care. Primary responsibilities include, but are not limited to, assigning duties to staff members based on ratios/volumes, skills, and departmental needs, identifying and mitigating problems as they occur, and addressing performance issues. Demonstrates the ability to meet the needs and provide service to all age groups.
Join one of the largest healthcare systems in the Baltimore-Washington metro region, also recognized as one of the "Healthiest Maryland Businesses". Apply today and learn how MedStar Health can be your next great career move!
Primary Duties:
  • Leads and supervises the Case Management team, including recruitment, onboarding, orientation, training, competency assessments, performance evaluations, and ongoing professional development for social work staff.
  • Oversees daily department operations by managing staffing, patient census, case assignments, and workflow to ensure efficient care coordination, utilization management, discharge planning, and resource allocation.
  • Supports the strategic and operational direction of the Case Management program by integrating social work, utilization management, and case management services, monitoring key performance indicators, managing departmental budgets, and driving quality improvement initiatives.
  • Collaborates with physicians, clinical leadership, regulatory agencies, and community partners to address medical necessity, denials management, documentation, post-acute care planning, compliance, and complex patient care needs while escalating high-risk issues appropriately.
  • Represents the department through multidisciplinary committees, community outreach, and partnerships with internal and external stakeholders to enhance patient outcomes, regulatory compliance, and operational excellence.

Qualifications:
  • Master's Degree (Required)
  • 3-4 years of relevant acute care work experience (Required)
  • 2-3 years of Case Management or Social Work experience (Preferred)
  • 2-3 years of progressive leadership experience

Licenses/Certifications:
• LGSW - Licensed Graduate Social Worker with independent license within one year of hire (Required)
• LMSW - Licensed Master Social Worker - State Licensure 3-4 years of relevant acute care work experience with independent license within one year of hire (Required)
• LCSW-C - Licensed Certified Social Worker - Clinical-3 years of Case Management or Social Work experience (Required)
• LICSW - Licensed Independent Clinical Social Worker (Required)
  • CCM - Certified Case Manager from a nationally recognized certification agency (Preferred)

This position has a hiring range of
USD $102,606.00 - USD $196,996.00 /Yr.

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About Medstar Health

Sourced by ZipRecruiter

MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Columbia, MD, US

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