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Utilization Manager Jobs in Washington (NOW HIRING)

MedStar Health

RN Utilization Mgmt

Washington, DC · On-site

$89K - $162K/yr

About the Job General Summary of Position The RN Utilization Manager will have 1-2 years of Utilization review- responsible for evaluating the necessity, appropriateness and efficiency of the use of ...

MedStar Health

RN Utilization Management

Washington, DC · On-site

$89K - $162K/yr

Monitors utilization of all services for fraud and abuse. * Performs pre-authorization and pharmacy ... CCM - Certified Case Manager CCM (Certified Case Manager) Upon Hire preferred Knowledge Skills and ...

Sedgwick

RN Utilization Review

Annapolis, MD

$73K - $75K/yr

To provide timely, evidence-based utilization review services to maximize quality care and cost-effective outcomes. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive ...

Sedgwick Law

RN Utilization Review

Washington, DC

$73K - $75K/yr

To provide timely, evidence-based utilization review services to maximize quality care and cost-effective outcomes. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive ...

Highmark Health

Senior Pharmacist - Strategy

Annapolis, MD

$57.75 - $69.25/hr

Formulary & Utilization Management Strategy & Development: May lead Highmark's evidence-based medicine drug evaluation program supporting Highmark's formulary and utilization management (UM) and/or ...

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All JobsUtilization Manager JobsUtilization Manager Jobs in Washington

Utilization Manager information

See Washington salary details

$44.2K

$103.1K

$189.7K

How much do utilization manager jobs pay per year?

As of Jun 10, 2026, the average yearly pay for utilization manager in Washington is $103,079.00, according to ZipRecruiter salary data. Most workers in this role earn between $67,400.00 and $124,000.00 per year, depending on experience, location, and employer.

What does a Utilization Manager do?

A Utilization Manager is responsible for evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. Their primary goal is to ensure that patients receive the right care at the right time while also controlling costs for hospitals, insurance companies, or healthcare organizations. Utilization Managers review patient records, coordinate with healthcare providers, and use clinical guidelines to make informed decisions about treatment approvals or denials. They play a key role in maintaining quality care and regulatory compliance.

What are the key skills and qualifications needed to thrive as a Utilization Manager, and why are they important?

To thrive as a Utilization Manager, you need a solid background in healthcare management, case review, and knowledge of insurance regulations, often supported by a degree in nursing, healthcare administration, or a related field. Familiarity with utilization management software, electronic health records (EHRs), and certification such as Certified Case Manager (CCM) are typically required. Strong analytical thinking, communication, and negotiation skills help Utilization Managers effectively coordinate care and collaborate with providers. These skills ensure appropriate resource use, regulatory compliance, and optimal patient outcomes within healthcare organizations.

What are some common challenges faced by Utilization Managers, and how can they be addressed?

Utilization Managers often face challenges such as balancing cost containment with patient care quality, navigating complex insurance policies, and managing high caseloads. To address these, effective communication with healthcare providers and payers is essential, as is staying current with regulatory requirements and best practices. Building strong relationships within interdisciplinary teams and leveraging data analytics tools can also help Utilization Managers make informed decisions and improve workflow efficiency.

What Is a Utilization Manager?

A utilization manager works in the insurance industry to analyze health care needs in medical cases and determine further patient care. In this career, your job duties include conducting interviews to determine what services you register for and cutting down on unnecessary costs. You may review medical records and compile documentation to improve care and report your findings. Skills in management, customer service, and health care services are vital in this career. Job experience in nursing is a benefit when applying for utilization manager positions. Additional qualifications include a bachelor’s degree and medical case management certificate.

What is the difference between Utilization Manager vs Utilization Coordinator?

AspectUtilization ManagerUtilization Coordinator
CertificationsOften requires healthcare or case management certificationsMay have similar certifications but less emphasis on management
Work EnvironmentTypically in healthcare organizations, overseeing utilization review processesSupports daily operations, assisting with case documentation and scheduling
Employer & Industry UsageCommon in healthcare, insurance, and managed care companiesFound in similar settings, often working under Utilization Managers

In summary, a Utilization Manager generally has broader responsibilities, overseeing utilization review and resource allocation, while a Utilization Coordinator focuses on supporting daily tasks and documentation. Both roles are integral in healthcare settings but differ in scope and level of responsibility.

More about Utilization Manager jobs
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What cities in Washington are hiring for Utilization Manager jobs? Cities in Washington with the most Utilization Manager job openings:
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Utilization Manager jobs near you
Clinical Nurse - Utilization Manager

Clinical Nurse - Utilization Manager

Saratoga Medical

Falls Church, VA • On-site

Other

Medical, PTO

This job post has expired 1 day ago. Applications are no longer accepted.

Job description

Saratoga Medical is hiring for a Clinical Nurse, Medical Management/Utilization Management in Falls Church, Virginia. Package includes competitive rate, paid time off and benefit options.
This is a great full-time opportunity with telework available. Please see the qualifications below and submit your resume if you are interested in being considered.
Required Qualifications:

  • Bachelor's degree in Nursing, Master's preferred, or other clinically related Health Service degree.
  • Department of Defense Program Management (PM) experience preferred, minimum 2 years within the last 5 years.
  • Experience in the operations and organization of the Department of Defense Military Health System desired.

Saratoga Medical Center, Inc. is an equal opportunity employer and will not discriminate in recruiting, hiring, training, promotion, transfer, discharge, compensation or any other term or condition of employment on the basis of race, religion, color, age (over age 39), sex, national origin, or on the basis of disability if the employee can perform the essential functions of the job, with a reasonable accommodation if necessary.

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