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Utilization Review Case Manager Jobs in Washington, DC

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 · On-site

$33.60 - $50.40/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 Review Case JobsUtilization Review Case Manager JobsUtilization Review Case Manager Jobs in Washington, DC

Utilization Review Case Manager information

See Washington, DC salary details

$18

$41

$68

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

As of Aug 14, 2026, the average hourly pay for utilization review case manager in Washington, DC is $41.34, according to ZipRecruiter salary data. Most workers in this role earn between $33.51 and $43.61 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, DC?

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

What job categories do people searching Utilization Review Case Manager jobs in Washington, DC look for?

The top searched job categories for Utilization Review Case Manager jobs in Washington, DC are:

Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Washington, DC as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 12% Part Time, and 2% Contract. Highlights an 94% Physical, 2% Hybrid, and 4% Remote job distribution, with an average salary of $85,996 per year, or $41.3 per hour.

Travel Nurse RN - Case Manager, Utilization Review - $2,917 per week

American Traveler

Silver Spring, MD • On-site

$2.9K/wk

Other

Medical, Dental, Vision, Life, Retirement

Re-posted 14 days ago

Job description

American Traveler is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Silver Spring, Maryland.

Job Description & Requirements
  • Specialty: Utilization Review
  • Discipline: RN
  • Start Date: ASAP
  • Duration: 13 weeks
  • 40 hours per week
  • Shift: 8 hours, days
  • Employment Type: Travel
Assignment Overview
  • Shift: Days, 5x8hrs
  • Hours: 40 hrs/wk
  • Start Date: May 4, 2026
  • Length: 13 weeks
  • Openings: 1
Description

American Traveler is hiring a travel RN Case Manager for a 13-week acute inpatient care coordination role requiring at least 1 year of acute care experience and knowledge of health care reimbursement systems.

Details
  • Acute inpatient hospital setting focused on care coordination and discharge planning
  • Day shift: 8:30 AM to 5:00 PM, 8-hour shifts
  • 40 hours per week
  • Uses Epic EMR
Requirements
  • Active MD or Compact RN license required — no pending licenses accepted
  • Associate's Degree in Nursing (ADN) required
  • Minimum 1 year of experience in an acute medical/surgical, ED, or critical care nursing setting
  • Experience using an electronic medical record (EMR) system
  • Knowledge of health care reimbursement systems including Medicare Advantage, commercial payers, Medicaid, and CMS regulatory rules
  • Epic EMR experience
  • Last 4 digits of SSN and date of birth required for consideration
Additional Information
  • Responsible for overseeing management and coordination of care for the acute inpatient population
  • Completes initial face-to-face assessments for every admitted patient within 24 hours of admission to identify discharge needs
  • Collaborates with hospital-based physicians, patients and families, nursing, utilization review, and other healthcare team members to support clinical and cost-effective outcomes
  • Coordinates referrals with in-network vendors for post-acute levels of care including Home Health, DME, IV Infusion, SNF Sub-Acute, and Acute Rehab
  • Facilitates transitions of care with community providers and ambulatory case managers to support safe discharge and reduce readmissions
  • Documents assessment outcomes and discharge plans in accordance with facility policies and regulatory requirements
  • Local candidates are welcome to apply
  • Travelers may not exceed two years of cumulative assignment time within the facility's system without a 90-day consecutive break

American Traveler Job ID #P-699792. Pay package is based on 8 hour shifts and 40 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Travel RN - Case Management/Utilization Review - Case Management

About American Traveler

With over 25 years of experience, American Traveler has established a reputation for outstanding customer service. Our team ensures a smooth, worry-free experience for those starting on or expanding their travel nursing and allied careers.

With thousands of travel nursing and allied jobs nationwide, our attentive and approachable recruiters find positions that align perfectly with your career aspirations and personal requirements.

American Traveler offers exceptional benefits, including premium medical, dental, vision and life insurance beginning day one of your assignment, generous 401(k) match, substantial housing stipends, and more. Additionally, with 24/7 support and access to our in-house clinicians, you are assured confidence and comfort throughout your assignment.

With our team behind you, you can relax and enjoy a rewarding travel career.

Why Vivian Health?

Be sure to apply via Vivian Health to increase your chances of landing your perfect job. Just complete your Vivian Health profileonce, and get access to thousands of opportunities across the country. Then keep up to date with your job application process and conversations with our easy to use app.

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