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Utilization Review Manager Jobs in 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 ...

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 ...

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 ...

The Utilization Assistant provides support to all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of ...

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Utilization Review Manager information

See Washington, DC salary details

$44.2K

$103.1K

$189.7K

How much do utilization review manager jobs pay per year?

As of Aug 14, 2026, the average yearly pay for utilization review manager in Washington, DC 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.

Is utilization review a stressful job?

Utilization review managers oversee the assessment of healthcare services to ensure appropriate and efficient care, which can involve high workloads and strict deadlines, leading to stress. The job requires strong organizational skills, attention to detail, and the ability to handle complex cases, which may contribute to job-related stress for some individuals.

What are some common challenges faced by utilization review managers in balancing patient care and cost efficiency?

Utilization Review Managers often encounter the challenge of ensuring patients receive appropriate care while also adhering to insurance and regulatory guidelines that emphasize cost efficiency. This requires strong analytical skills to assess clinical information and make fair determinations, often under tight deadlines and with incomplete data. The role also involves frequent communication with physicians, payers, and case managers to resolve disagreements and clarify criteria, making negotiation and diplomacy essential. Staying updated on changing healthcare regulations and payer requirements can add to the complexity, but it also provides opportunities for professional growth and leadership within healthcare administration.

What are the key skills and qualifications needed to thrive as a utilization review manager?

To thrive as a Utilization Review Manager, you need a solid background in healthcare management, clinical knowledge (often as an RN or healthcare professional), and experience with utilization review processes. Familiarity with case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Utilization Review (CPUR) are often expected. Strong analytical thinking, attention to detail, leadership, and effective communication are crucial soft skills for success in this role. These skills ensure appropriate resource use, regulatory compliance, and coordinated patient care, which are vital for both healthcare quality and operational efficiency.

What is the difference between Utilization Review Manager vs Utilization Review Coordinator?

AspectUtilization Review ManagerUtilization Review Coordinator
CertificationsTypically requires certifications like CCM or ACUMay require similar certifications but often less advanced
Work EnvironmentSupervises review teams, manages processes in healthcare or insurance settingsPerforms case reviews, supports the review process under supervision
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare providers, third-party administrators

The Utilization Review Manager oversees review teams and manages utilization review processes, focusing on policy compliance and efficiency. The Utilization Review Coordinator supports the review process by conducting case assessments and assisting managers. While both roles require similar certifications and work in related environments, the manager holds a supervisory position with broader responsibilities.

What does a utilization review manager do?

A Utilization Review Manager oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that patient care adheres to established guidelines and that healthcare resources are used effectively. Their duties typically include leading a team of reviewers, collaborating with healthcare providers, ensuring compliance with regulations, and making recommendations on care authorization. The goal is to balance quality patient care with cost-effective resource management.

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

The most popular types of Utilization Review jobs in Washington, DC are:

Infographic showing various Utilization Review 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 $103,079 per year, or $49.6 per hour.

Utilization Review Manager (Behavioral Health Supervisor)

Fairfax County

Fairfax, VA • On-site

$84K - $148K/yr

Full-time

Posted 7 days ago


Fairfax County rating

8.1

Company rating: 8.1 out of 10

Based on 68 frontline employees who took The Breakroom Quiz

345th of 846 rated public administrative organizations


Job description

Job Announcement Are you a knowledgeable behavioral health professional seeking ways to support youth with intensive needs and their families from our community. Do you have an interest in system-level work by building collaborative partnerships to promote access to high-quality care. Do you have skills navigating policy and managing detailed information.

If so, we invite you to apply for the position of Children's Services Act (CSA) Utilization Review Manager. This is an exciting time to join Fairfax-Falls Church System of Care as a member of the CSA team to meet the behavioral health needs of children and youth in our community. This position plays a critical role in serving children and families in our community who require intensive behavioral health interventions and support.

Supervises a team of senior clinicians to review requests for services and authorize funding for a continuum of services and supports. Working closely with staff from child-serving agencies such as child welfare, juvenile justice, special education and community mental health, the UR team ensures that high quality, effective interventions that are trauma-informed and evidence-based are offered. This position works closely with quality assurance, procurement, fiscal teams and data analytics to balance service delivery with effective, outcome- focused interventions.

This position requires a detail-oriented and analytical professional who can manage and interpret complex policy and unique child-specific needs in a dynamic human service environment, working collaboratively with various partners to implement a System of Care model. Under general guidance of the CSA Program Manager, performs the following duties and responsibilities: Supervises and manages a team of behavioral health senior clinicians to review and authorize requests for intensive behavioral health services and supports Provides oversight to ensure service authorizations comply with state and local policy meeting programmatic and fiscal audit standards Participates in management and leadership teams as well as interagency workgroups to support strategic initiatives aimed at improving equitable access, effective service delivery and improved outcomes for youth involved in child welfare, juvenile justice and special education Leads collaborative efforts and engages with private provider partners to ensure a full continuum of high quality, trauma-informed and evidence-based interventions are available Supports implementation of the System of Care model in Fairfax-Falls Church to accomplish strategic priorities for youth with complex, intensive needs Utilizes technology solutions, electronic documentation systems, and virtual platforms for efficient business processes in a dynamic human services environment. Collects and analyzes qualitative and quantitative data to provide management reports to leadership about service trends, gap analyses and other program metrics Illustrative Duties (The illustrative duties listed in this specification are representative of the class but are not an all-inclusive list.

A complete list of position duties and unique physical requirements can be found in the position description.) Provides staff supervision for all clinical aspects of the program; Plans, assigns, and reviews work of team members; Consults with professionals on a variety of problems including delivery of needed services for clinically complex cases; Provides liaison to community agencies to facilitate communication and service provision for individuals requiring multiple services; Develops and implements program activities and services, including training and educational activities; Supervises day-to-day program operations; Promotes awareness of program services through presentations; Develops and monitors program's policies and procedures; Ensures that program is in compliance with applicable federal, state, and local policies, regulations, and statutes; Mediates and facilitates inter-and intra-program issues needing a systems perspective; Plans, recommends, and executes quality initiatives related to mental health standards; Required Knowledge Skills and Abilities (The knowledge, skills and abilities listed in this specification are representative of the class but are not an all-inclusive list.) Extensive knowledge of the principles, theories, and methods of the psychological and social development of humans; Thorough knowledge of and ability to implement recovery oriented practices and person-centered planning; Knowledge of psychiatric, psychological, sociological, and addiction terminology and concepts; Knowledge of clinical supervisory methods and techniques; Knowledge of existing referral agencies and community resources; Demonstrated case management skills; Ability to evaluate the severity of individuals' substance use, psychiatric symptoms, and impact on daily functioning; and implement commensurate level of treatment and support; Ability to prepare, produce, and conduct program presentations; Ability to develop, implement, manage, and evaluate programs; Ability to supervise and train service professionals; Ability to successfully perform as a team leader/member; Ability to evaluate performance, provide feedback, coach, correct, and implement personnel procedures; Ability to function independently in high stress situations; Ability to develop and maintain effective working relationships with subordinates, co-workers, supervisors, public and private sector organizations, community groups, and the general public; Ability to successfully perform as a team leader/member; Ability to communicate effectively, both orally and in writing; Ability to maintain records and prepare reports. Employment Standards MINIMUM QUALIFICATIONS: Graduation from an accredited college with at least a master's degree in social work, psychology, counseling, or nursing plus three years of clinical experience or a doctoral degree in psychology, social, counseling or nursing plus one year of clinical experience. Must be eligible to be licensed to practice in the Commonwealth of Virginia in one of the following: Licensed Clinical Social Worker, Licensed Professional Counselor, Clinical Psychologist, Licensed Marriage and Family Therapist, Licensed Substance Abuse Treatment Practitioner or Licensed Nurse Practitioner (LNP)

CERTIFICATES AND LICENSES REQUIRED: Licensed to practice in the Commonwealth of Virginia in one of the following: Licensed Clinical Social Worker, Licensed Professional Counselor, Clinical Psychologist, Licensed Marriage and Family Therapist, Licensed Substance Abuse Treatment Practitioner or Licensed Nurse Practitioner (Required within 24 months) Valid driver's license NECESSARY SPECIAL REQUIREMENTS: The appointee to this position will be required to complete a criminal background check, child protective services check, and driving record check to the satisfaction of the employer. PREFERRED QUALIFICATIONS: At least 3 years of experience with supervision of professional staff At least 2 years of professional human services work experience in at least two areas. At least 2 years of professional experience monitoring behavioral health care services.

Advanced knowledge of trauma-informed, evidence-based mental health/behavioral health care interventions for children, youth and families. At least 2 years of experience in at least two of the following areas: utilization review, monitoring of purchased mental health/behavioral health care service, collection of standardized data elements via file audits and document reviews, preparing written social histories, assessments, and reports describing the needs of children and families, and use of assessment tools (examples: CANS, VEMAT, YASI, etc.) and decision support models At least intermediate proficiency with Excel. PHYSICAL REQUIREMENTS: Ability to communicate clearly and concisely, both orally and in writing

Ability to travel to visit clients, conduct site reviews and attend meetings off-site. Ability to use automated technology. Employee may require to lift up to 15 lbs (all duties).

Visual acuity is required to read data on computer monitor, incumbent must be able to operate keyboard driven equipment. All duties performed with or without reasonable accommodations. SELECTION PROCEDURE: Panel interview and may include exercise.

Fairfax County is home to a highly diverse population, with a significant number of residents speaking languages other than English at home (including Spanish, Asian/Pacific Islander, Indo-European, and many others.) We encourage candidates who are bilingual in English and another language to apply for this opportunity. Fairfax County Government prohibits discrimination on the basis of race, color, religion, national origin, sex, pregnancy, childbirth or related medical conditions, age, marital status, disability, sexual orientation, gender identity, genetics, political affiliation, or military status in the recruitment, selection, and hiring of its workforce. Reasonable accommodations are available to persons with disabilities during application and/or interview processes per the Americans with Disabilities Act

TTY 703-222-7314. DHREmployment@fairfaxcounty.gov EEO/AA/TTY. #LI-JY1


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