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Utilization Manager Jobs in Washington (NOW HIRING)

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 · 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 · 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 ...

Decypher

Registered Nurse Case Manager

Bethesda, MD · On-site

$40 - $50/hr

The Registered Nurse Case Manager provides comprehensive case management and referral/utilization management services, coordinating patient care across the continuum to promote quality, cost ...

New

Decypher

Registered Nurse Case Manager

Bethesda, MD · On-site

$40 - $50/hr

The Registered Nurse Case Manager provides comprehensive case management and referral/utilization management services, coordinating patient care across the continuum to promote quality, cost ...

New

Decypher

Registered Nurse Case Manager

Bethesda, MD · On-site

$40 - $50/hr

The Registered Nurse Case Manager provides comprehensive case management and referral/utilization management services, coordinating patient care across the continuum to promote quality, cost ...

New

Decypher

Registered Nurse - Case Manager

Bethesda, MD · On-site

$40 - $50/hr

The Registered Nurse - Case Manager provides comprehensive case management and referral/utilization management services, coordinating patient care across the continuum to promote quality, cost ...

New

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 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 Sep 5, 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 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 are the key skills and qualifications needed to thrive as a utilization manager?

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 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

What are the most commonly searched types of Utilization jobs in Washington?

The most popular types of Utilization jobs in Washington are:

What are popular job titles related to Utilization Manager jobs in Washington?

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

What job categories do people searching Utilization Manager jobs in Washington look for?

The top searched job categories for Utilization Manager jobs in Washington are:

What cities in Washington are hiring for Utilization Manager jobs?

Cities in Washington with the most Utilization Manager job openings:

What are popular job titles related to Utilization Manager jobs in WA?

For Utilization Manager jobs in WA, the most frequently searched job titles are:

Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Washington as of August 2026, with employment types broken down into 84% Full Time, 9% Part Time, 2% Temporary, and 5% Contract. Highlights an 77% Physical, 2% Hybrid, and 21% Remote job distribution, with an average salary of $103,079 per year, or $49.6 per hour.

Director Utilization Management MedStar Family Choice

MedStar Health

Washington, DC • On-site

$120K - $238K/yr

Full-time

Re-posted 5 days ago

Key responsibilities

  • Leads enterprise-wide utilization management strategy and ensures consistency across all health plans.

  • Oversees prior authorization, concurrent review, and retrospective review processes to ensure timely and compliant determinations.

  • Develops and monitors performance dashboards, identifies utilization trends, and implements process improvements to enhance operational efficiency.

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 240 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 Utilization Management (UM) provides strategic and operational leadership for the health plan's centralized utilization management function across both plans. This role ensures appropriate evidence-based utilization of services while maintaining regulatory compliance improving quality outcomes and driving cost-effective delivery. Under a centralized clinical operation model the Director aligns UM process across plans standardizes workflows optimizes technology and integrates closely with Case Management Pharmacy Quality and Provider Relations to support enterprise-wide performance goals.
Primary Duties and Responsibilities
  • Leads enterprise-wide utilization management strategy across all health plans under a centralized clinical operation model.
  • Standardizes UM policies workflows and clinical criteria application to ensure consistency and scalability across markets.
  • Oversees prior authorization concurrent review retrospective review to ensure timely and compliant determinations.
  • Ensures compliance with state Medicaid NCQA CMS and contractual requirements including turnaround time standards.
  • Partners with medical directors to ensure appropriate clinical decision-making and consistent application of medical necessity criteria.
  • Develops and monitors UM performance dashboards including denial rates overturn rates length of stay and turnaround times.
  • Drives medical expense management initiatives by identifying utilization trends and implementing targeted interventions.
  • Collaborates with Case Management leadership to ensure seamless transitions between UM and care coordination functions.
  • Partners with pharmacy leadership to align utilization controls on high-cost drugs and specialty therapies.
  • Oversees hospital utilization management including inpatient admission appropriateness DRG optimization and reduction strategies.
  • Identifies and implements process improvement initiatives to increase operational efficiency and reduce variability.
  • Prepares for a lead regulatory audits accreditation reviews and corrective action plans related to UM functions.
  • Monitors and ensures compliance with evidence-based clinical criteria tools (e.g. InterQual ASAM) and internal policies.
  • Leads workforce planning and staffing models to ensure appropriate caseload distribution and productivity standards.
  • Supervises and develops UM managers and supervisors including performance evaluations and professional development.
  • Collaborates with Finance and Actuarial team to analyze utilization trends cost drivers and forecast medical expense impact.
  • Supports value-based payment models and alternative payment initiatives by aligning UM process with performance metrics.
  • Develops escalation and peer review process to manage complex or high-risk clinical determinations.
  • Ensures culturally competent and member- center decision-making balancing access quality and cost stewardship.
  • Provides executive-level reporting and strategic recommendation to the VP of Clinical Operations and senior leadership
    • Minimal Qualifications
    Education
    • Bachelor's degree Bachelor's degree in Nursing Social Work or related healthcare field required
    • Master's degree Master's degree in Nursing (MSN) Public Health (MPH) Healthcare Administration (MHA) Business Administration (MBA) or related field preferred
    Experience
    • 8-10 years years of managed care experience required and
    • 5-7 years Minimum 5 years utilization management leadership required and
    • Experience with centralized operations preferred and
    • Demonstrated experience in Medicaid managed care preferred
    Licenses and Certifications
    • RN - Registered Nurse - State Licensure and/or Compact State Licensure in MD/DC Upon Hire required
    Knowledge Skills and Abilities
    • Deep understanding of state Medicaid CMS and NCQA requirements
    • Experience in medical necessity criteria tools (InterQual)
    • Strong data analytics and financial acumen
    • Change management expertise
    • Excellent executive communication skills.

    This position has a hiring range of
    USD $120,702.00 - USD $238,222.00 /Yr.

    What Medstar Health employees say

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    Benefits

    Hours and flexibility

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    Get the full story on Breakroom

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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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