Director, Utilization Management, MedStar Family Choice

MedStar Health; Washington (District of Columbia); On-site; USD 140,000 - 180,000; Full time

Benefits offered by this job

Health benefits

Generous PTO

Tuition assistance

Retirement plans

Wellbeing programs

Job summary

MedStar Health is seeking a Director of Utilization Management to provide strategic and operational leadership for centralized utilization management across health plans in Maryland and the District of Columbia.

The role focuses on ensuring evidence-based, cost-effective care, regulatory compliance, and collaboration with Case Management, Pharmacy, Quality, and Provider Relations to improve outcomes.

Qualifications

• 8-10 years of managed care experience.
• 5-7 years minimum in utilization management leadership.
• RN licensure in MD/DC is required or eligible.

Responsibilities

• Provide strategic and operational leadership for centralized utilization management across health plans.
• Align UM processes across plans and standardize workflows.
• Promote evidence-based use of services while ensuring regulatory compliance and cost-effective care.
• Collaborate with Case Management, Pharmacy, Quality, and Provider Relations to support performance goals.

Skills

Medicaid knowledge

Data analytics

Financial acumen

Education

Bachelor's degree in Nursing or related field

Master's degree in Nursing or related field preferred

Tools

InterQual

Job description

As a provider-sponsored managed care plan, MedStar Family Choice serves members across Maryland and the District of Columbia. We’re currently hiring talented professionals for roles including case management, utilization management, quality improvement, appeals and grievances, and leadership.

The Director of Utilization Management (UM) provides strategic and operational leadership for centralized utilization management across both health plans. This role promotes appropriate, evidence-based use of services while ensuring regulatory compliance, improving quality outcomes, and supporting cost-effective care. The Director aligns UM processes across plans, standardizes workflows, optimizes technology, and collaborates with Case Management, Pharmacy, Quality, and Provider Relations to support organization-wide performance goals.

MedStar Health is a great place to work and grow your career.

We provide a supportive and inclusive work environment,

• comprehensive health and wellness benefits
• generous PTO
• tuition assistance
• retirement plans
• many other benefits focused on your wellbeing

Minimum Qualifications

Education

• Bachelor's degree Bachelor's degree in Nursing Social Work or related healthcare field
• 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
• 5-7 years Minimum 5 years utilization management leadership
• Experience with centralized operations preferred
• Demonstrated experience in Medicaid managed care preferred

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure in MD/DC

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

About MedStar Health

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 33,000 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.