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Utilization Management Jobs in Washington, DC (NOW HIRING)

Evolent

Internal Medicine Physician

Arlington, VA · On-site

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 ...

Evolent

Radiology Physician

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 ...

UHS

Utilization Review Coordinator

Washington, DC · On-site

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 ...

UHS

Utilization Review Coordinator

Washington, DC

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 ...

UHS

Utilization Review Coordinator

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 ...

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All JobsUtilization Management JobsUtilization Management Jobs in Washington, DC

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.

Pharmacy Director - Health Plan

MedStar Health

Columbia, MD • On-site

$348K/yr

Full-time

Re-posted yesterday

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 241 frontline employees who took The Breakroom Quiz

136th of 898 rated healthcare providers

Job description

About the Job
General Summary of Position
The Director of Pharmacy provides strategic leadership and operational oversight for pharmacy benefit management formulary strategy medication utilization and pharmacy quality initiatives across the health plan. This role is responsible for ensuring safe cost effective and evidence-based medication use while supporting regulatory compliance value-based care initiatives and population health goals. The Director collaborates with clinical leadership pharmacy benefit managers (PBMs) providers and health plan operations to optimize pharmacy programs that improve patient outcomes and manage total cost of care.
Primary Duties and Responsibilities
  • Develop and implement the health plan pharmacy strategy aligned with organizational goals and population health priorities.
  • Lead formulary management pharmacy policy development and medication utilization management programs.
  • Provide oversight of pharmacy benefit design and cost containment initiatives.
  • Manage relationships with pharmacy benefit managers (PBMs) and specialty pharmacy vendors.
  • Oversee formulary development rebate programs contract performance and pharmacy network management.
  • Monitor pharmacy benefit performance metrics and implement improvement initiatives.
  • Direct programs such as: Prior authorization step therapy medication therapy management (MTM) specialty pharmacy management
  • Ensure clinical programs are evidence based and aligned with national guidelines and regulatory requirements.
  • Ensure compliance with CMS NCQA state regulations and accreditation standards related to pharmacy services.
  • Support Medicaid pharmacy program requirements as applicable.
  • Lead pharmacy-related quality initiatives and performance reporting.
  • Use pharmacy claims and clinical data to: Identify utilization trends manage drug spend support value-based care models.
  • Develop dashboards and reporting to monitor pharmacy performance indicators.
  • Collaborate with physicians pharmacists and care management teams to optimize medication use.
  • Serve as a subject matter expert on pharmacy policy and medication management.
  • Support provider education on formulary updates and pharmacy programs.
  • Recruit develop and supervise pharmacy and clinical staff.
  • Foster a culture of collaboration accountability and continuous improvement.

Minimal Qualifications
Education
  • Bachelor's degree Graduate training in an accredited College of Pharmacy. required
  • Doctoral degree Doctor of Pharmacy (PharmD) required
  • Advanced degree (MBA MPH MHA) preferred

Experience
  • 8-10 years Pharmacy leadership experience required
  • Significant experience in health plan pharmacy PBM operations or managed care pharmacy required
  • Experience with Medicare Part D Medicaid or commercial pharmacy benefits preferred Certifications required

Licenses and Certifications
  • PharmD - licensed pharmacist in the District of Columbia and Maryland or eligibility for reciprocity upon hire (required)
  • BCPA-Board Certified Patient Advocate Board Certification (e.g. BCPS BCACP) preferred
  • PTCB - Pharmacy Technician Certification Board Board Certification (e.g. BCPS BCACP) preferred
  • PHARMACOTH - Board Certified Pharmacotherapy Specialist Board Certification (e.g. BCPS BCACP) preferred

Knowledge Skills and Abilities
  • Managed care pharmacy expertise
  • Pharmacy benefit design and formulary management
  • Regulatory and accreditation knowledge (CMS NCQA)
  • Financial and utilization analytics
  • Strategic leadership and change management
  • Stakeholder collaboration and communication
  • Pharmacy cost trend and total drug spend
  • Medication adherence and quality metrics
  • Formulary compliance and utilization management outcomes
  • PBM contract performance
  • Regulatory and accreditation compliance

This position has a hiring range of
USD $161,158.00 - USD $348,296.00 /Yr.

What Medstar Health employees say

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About Medstar Health

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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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