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Utilization Review Case Manager Jobs in Washington

Constellis

Case Reviewer

VA · On-site

POSITION SUMMARY The Case Manager scrutinizes reports of investigations submitted by the Field ... Review case work and provide feedback regarding quality and completeness * Contact Field ...

Constellis

Case Reviewer

VA · On-site +1

POSITION SUMMARY The Case Manager scrutinizes reports of investigations submitted by the Field ... Review case work and provide feedback regarding quality and completeness * Contact Field ...

Comagine Health

Clinical Reviewer DC

Washington, DC · On-site

Act as a resource for peers and or others (care management staff) regarding utilization review related questions and or review processes. * Assist with appeal case preparation for medical affairs and ...

Housing Up

Floating Case Manager

Washington, DC · On-site

$50K - $55K/yr

Floating Case Manager, Permanent Supportive Housing FLSA Status: Full-time, Exempt Department ... Quickly assess client needs, review case records, andestablishrapport with participants to ensure ...

Comagine

Clinical Reviewer DC

Washington, DC · On-site

Act as a resource for peers and or others (care management staff) regarding utilization review related questions and or review processes. * Assist with appeal case preparation for medical affairs and ...

Inova

Manager Case Management

Falls Church, VA

$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 ...

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Utilization Review Case Manager information

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

As of Aug 20, 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 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 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 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 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 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 August 2026, with employment types broken down into 55% Full Time, and 45% Contract. Highlights an 100% In-person job distribution, with an average salary of $85,954 per year, or $41.3 per hour.

Nurse CARE Manager, Wellness Center & Case Management

Marriott International

Bethesda, MD • On-site

$84K - $147K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 4 days ago

Marriott International rating

6.4

Company rating: 6.4 out of 10

Based on 1,186 frontline employees who took The Breakroom Quiz

54th of 108 rated hotels

Job description


JOB SUMMARY
The Nurse CARE Manager provides dual support through direct clinical care at the Marriott Headquarters Wellness Center and nurse case management (NCM) services for the Eastern Region Claims Services office. This role delivers high-quality, on-site occupational health services as well as coordinating care for work-related injuries and illnesses to promote early return to work and minimize workers' compensation losses.
At our Wellness Center, the Nurse CARE Manager provides onsite clinical care, supports wellness and occupational health programs, and ensures compliance with regulatory and organizational standards. For our Eastern Region Claims office, the role is responsible for conducting first level Utilization Review and coordinates subsequent levels, if necessary, as required by jurisdiction. This position is responsive to Marriott's associates, Marriott Claims Services, business units, Risk Management and community health resources. Quality, cost effective health services that meet the needs of Marriott associates are a foremost priority in this role.
CANDIDATE PROFILE
Education and Experience
Required
  • 5+ years' nursing experience
  • Current Licensed Registered Nurse (RN). Must be licensed to practice nursing in the State of Maryland.
  • Current BLS and CPR certification, with the ability to meet all applicable jurisdictional certification and licensure requirements.
  • Certification as an occupational health nurse and/or case manager (or, progress toward certification)
  • Strong clinical assessment skills with the ability to apply sound judgment in complex cases.
  • Demonstrated ability to apply strong communication, organizational, and critical thinking skills to assess patient needs, solve complex problems, and manage case workflows with a high level of efficiency and attention to detail.

Preferred
  • Knowledge of OSHA, ADA, and workers' compensation regulations
  • Familiarity with Workers' Compensation systems and care management requirements.
  • Experience in occupational health nursing with corporate or clinical setting.
  • Proven ability to coordinate care across multiple stakeholders, providers, and jurisdictions

CORE WORK ACTIVITIES
Clinical Care & Wellness Center Operations
  • Provide onsite evaluation, triage, and treatment of associate illnesses and injuries
  • Perform wound care and basic clinical interventions (e.g., splinting, suture removal)
  • Administer medications/vaccines and conduct point-of-care testing
  • Respond to workplace incidents and deliver immediate first aid support
  • Conduct screenings, health risk assessments, and wellness education
  • Maintain OSHA logs, ensure regulatory compliance, and manage accurate health records
  • Oversee clinic operations (equipment, inventory, scheduling), ergonomic assessments, standing orders, and workplace accommodations
  • Lead initial triage and ongoing coordination of care for injured associates
  • Conduct first-level utilization review and coordinate additional levels as required by jurisdiction
  • Communicate with providers and validate clinical documentation for accuracy and alignment
  • Coordinate diagnostics, referrals, and escalation to higher levels of care
  • Facilitate return to work (RTW) planning, restrictions tracking, and recovery oversight
  • Partner with adjusters and stakeholders to improve outcomes and reduce claim costs
  • Collaborate with leadership to enhance visibility into program performance and outcomes

Nurse Case Management
  • Lead initial triage and ongoing coordination of care for injured associates
  • Conduct first-level utilization review and coordinate additional levels as required by jurisdiction
  • Communicate with providers and validate clinical documentation for accuracy and alignment
  • Coordinate diagnostics, referrals, and escalation to higher levels of care
  • Facilitate return to work (RTW) planning, restrictions tracking, and recovery oversight
  • Partner with adjusters and stakeholders to improve outcomes and reduce claim costs
  • Collaborate with leadership to enhance visibility into program performance and outcomes

At Marriott International, we are dedicated to being an equal opportunity employer, welcoming all and providing access to opportunity. We actively foster an environment where the unique backgrounds of our associates are valued and celebrated. Our greatest strength lies in the rich blend of culture, talent, and experiences of our associates. We are committed to non-discrimination on any protected basis, including disability, veteran status, or other basis protected by applicable law.
About Us
All positions offer a 401(k) plan, stock purchase plan, discounts at Marriott properties, commuter benefits, employee assistance plan, and childcare discounts. Benefits are subject to terms and conditions, which may include rules regarding eligibility, enrollment, waiting period, contribution, benefit limits, election changes, benefit exclusions, and others. Click here to learn more.
Full-time positions also offer coverage for medical, dental, vision, health care flexible spending account, dependent care flexible spending account, life insurance, disability insurance, accident insurance, adoption expense reimbursements, paid parental leave and educational assistance.
Washington Applicants Only: Employees will accrue paid sick leave, 0.077 PTO balance for every hour worked and be eligible to receive a minimum of 9 holidays annually.
Marriott HQ is committed to a hybrid work environment that enables associates to Be connected. Headquarters-based positions are considered hybrid, for candidates within a commuting distance to Bethesda, MD; candidates outside of commuting distance to Bethesda, MD will be considered for Remote positions.
About the Team
Marriott International is the world's largest hotel company, with more brands, more hotels and more opportunities for associates to grow and succeed. Be where you can do your best work, begin your purpose, belong to an amazing global team, and become the best version of you.

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