RN Utilization Management Leader - Clinical Ops

MedStar Health; Washington (District of Columbia); On-site; USD 103,000 - 197,000; Full time

Job summary

MedStar Health seeks a senior manager for Utilization Management to lead clinical review of acute services, ensure medical necessity and appropriate discharge planning, and coordinate care across teams. The role emphasizes collaboration with interdisciplinary staff to optimize outcomes and resource use.

The position requires RN licensure, CCM certification, and a strong background in utilization management, population health, and regulatory compliance within a hospital system.

Qualifications

• Bachelor's degree from an accredited school of nursing.
• 3-4 years Utilization management experience.
• 5-7 years Diverse clinical experience.
• 1-2 years Supervisory experience.

Responsibilities

• Contributes to department goals and adheres to policies and safety standards.
• Leads validation of medical necessity using criteria and guidelines.
• Acts as liaison between IS and clinical teams to identify workflow issues.
• Analyzes UM monthly reports and reports trends to the Director.

Skills

Verbal communication

Written communication

Excel proficiency

PowerPoint

Education

Bachelor's degree in nursing

Tools

Microsoft Office

Job description

MedStar Health seeks a senior manager for Utilization Management to lead clinical review of acute services, ensure medical necessity and appropriate discharge planning, and coordinate care across teams. The role emphasizes collaboration with interdisciplinary staff to optimize outcomes and resource use.

The position requires RN licensure, CCM certification, and a strong background in utilization management, population health, and regulatory compliance within a hospital system.