ZipRecruiter

Log In

1

Utilization Review Case Manager Jobs in Washington

MedStar Health

RN Team Lead Utilization Review

Clinton, MD · On-site

$89K - $162K/yr

Collaborates with the physician nurse case manager social worker and other members of the health ... Acts as a resource and mentor to the Utilization Review staff. Primary Duties and Responsibilities

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 ...

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 ...

Encompass Health

Case Manager

Bowie, MD

$19.25 - $24.75/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * Must be qualified to ...

Inova

Manager Case Management

Falls Church, VA · On-site

$21.25 - $27.50/hr

Three (3) years of experience in case management or relevant nursing experience to include utilization review, discharge planning, outcomes management, transitional planning, assessment, care ...

Inova

Manager Case Management

Falls Church, VA · On-site

$154K - $170K/yr

Three (3) years of experience in case management or relevant nursing experience to include utilization review, discharge planning, outcomes management, transitional planning, assessment, care ...

Inova Health System

Manager Case Management

Falls Church, VA · On-site

$21.25 - $27.50/hr

Three (3) years of experience in case management or relevant nursing experience to include utilization review, discharge planning, outcomes management, transitional planning, assessment, care ...

next page

Showing results 1-20

All JobsUtilization Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Washington

Utilization Review Case Manager information

See Washington salary details

$18

$41

$68

How much do utilization review case manager jobs pay per hour?

As of Jul 29, 2026, the average hourly pay for utilization review case manager in Washington is $41.32, according to ZipRecruiter salary data. Most workers in this role earn between $33.51 and $43.56 per hour, depending on experience, location, and employer.

What are some common challenges Utilization Review Case Managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What is a Utilization Review Case Manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

What is the difference between Utilization Review Case Manager vs Utilization Review Nurse?

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

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

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.
What are popular job titles related to Utilization Review Case Manager jobs in Washington? For Utilization Review Case Manager jobs in Washington, the most frequently searched job titles are:
What job categories do people searching Utilization Review Case Manager jobs in Washington look for? The top searched job categories for Utilization Review Case Manager jobs in Washington are:
What cities in Washington are hiring for Utilization Review Case Manager jobs? Cities in Washington with the most Utilization Review Case Manager job openings:
Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Washington as of July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, and 3% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $85,954 per year, or $41.3 per hour.
RN Team Lead Utilization Review

RN Team Lead Utilization Review

MedStar Health

Clinton, MD • On-site

$89K - $162K/yr

Full-time

Posted 27 days ago

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 238 frontline employees who took The Breakroom Quiz

131st of 890 rated healthcare providers

Job description

About the Job
Candidate must have acute care Utilization Review experience. Candidate must live in the DC/Baltimore region
General Summary of Position
Supervises the daily activities of the Utilization Review Team. Manages daily assignment ensuring all UM tasks are completed each day. Collaborates with the physician nurse case manager social worker and other members of the health care team to meet individualized patient outcomes. Assists the Director in managing the daily departmental operations with the goal of maintaining adequate staffing levels and efficient workflow. Acts as a resource and mentor to the Utilization Review staff.
Primary Duties and Responsibilities
  • Supervises daily activities of UM team. Monitors and arranges for adequate staffing to ensure appropriate Utilization Review coverage for units. Monitors daily workflow issues and addresses issues related to workflow in collaboration with the director as necessary.
  • Acts as a resource and mentor for UM Team. Oversees the orientation of new UR Coordinators by establishing the plan and monitoring progress in conjunction with other staff as necessary Serves as a resource to all staff in areas of utilization review/management. Educates members of health care team through in-services staff meetings orientation and formal educational offerings. Completes continuing education to maintain knowledge base.
  • Collaborates with and assists the nurse case manager and social worker to meet the patients' continuing health needs in a high-quality cost-effective manner by identifying patients in need of case management. Participates in planning rounds as needed to address and communicate issues related to acuity level of patient LOS insurance and discharge needs.
  • Collects quality improvement data in accordance with approved indicators. Monitors and audits staff UM reviews for completeness and compliance with standards. Recognizes potential problems and provides education to staff.
  • Utilizes research methods to collect tabulate and analyze data in collaboration with the case management team medical staff and hospital performance improvement initiatives. Assists CM Leadership in implementing strategies to correct or modify trends seen through data analysis and outcome monitoring.
  • Confers and collaborates routinely with the physician advisor and attending physicians to resolve problems regarding acuity and level of care.
  • Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.
  • Identifies insurance information obtains authorization communicates with financial counseling and assigns appropriate length of stay for admission.
  • Implements strategies to avoid denials including potential denial notification to attending physician. Issues letter of non-coverage for Medicare or third-party payers according to policies and procedures. Communicates utilization plans to case management team. Evaluates concurrent and retrospective denials for appeal opportunities. Generates appeal letters based on knowledge of clinical severity and intensity.
  • Manages the department in the Director's absence. Keeps Director informed about issues related to staffing and problem areas. Keeps Director informed about issues related to quality risk patient/family issues and concerns allocation of resources and vendor/payer issues. Assists the Director in monitoring performance issues. Contributes to the performance evaluation process by giving feedback to the Director and helping create professional development plans for UR Coordinators.
  • Participates in multidisciplinary quality and service improvement teams.
  • Performs admission reviews and subsequent concurrent reviews to determine the necessity for acute care by application of accepted criteria based on age specific needs. Interacts with and assists third party payer reviewers to facilitate appropriate care and ensure payment of services. Performs concurrent and retrospective reviews telephonically as required. Completes all forms and documentation necessary to support appropriate utilization of resources.

Minimal Qualifications
Education
  • Bachelor's degree in Nursing required

Experience
  • 3-4 years clinical experience in acute care setting required
  • 2 years Case Management or Utilization Management experience preferred
  • 1-2 years leadership experience preferred

Licenses and Certifications
  • RN - Registered Nurse - State Licensure and/or Compact State Licensure the District of Columbia or State of Maryland depending on work location required
  • CCM - Certified Case Manager preferred

This position has a hiring range of
USD $89,065.00 - USD $162,801.00 /Yr.

What Medstar Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Medstar Health logo

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

Social media

FacebookTwitter

View All Medstar Health Jobs

Apply