RN Utilization Manager: HCBS & Care Coordination Lead

Optum; Washington (District of Columbia); On-site; USD 92,000 - 164,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive and recognition programs

401k contribution

Equity stock purchase

Job summary

Optum seeks an RN Utilization Manager to lead the DSNP clinical team in Washington, DC, coordinating HCBS reviews and care planning for members in home-based settings. You will partner with medical directors, providers, and plans to ensure high-quality utilization outcomes.

The role requires 3+ years in utilization management, strong leadership, and the ability to travel 25–50% within DC while maintaining clinical excellence and operational targets.

Qualifications

• Current unrestricted RN license in Washington DC.
• 3+ years of Utilization Management experience with focus on medical necessity reviews and team leadership.
• Proven ability to develop client relationships and manage data.
• Proficient computer skills including medical records documentation.

Responsibilities

• Set team direction and provide guidance to the DSNP clinical team.
• Oversee HCBS Review processes and collaborate with health plans and providers.
• Monitor performance metrics and drive care planning for members.
• Coordinate training, orientation, and knowledge sharing for clinical staff.
• Lead strategic planning and ensure timely care transitions and coordination.

Skills

Utilization management

Data analysis

Team leadership

Client relationships

Computer skills

Education

RN license

BSN (preferred)

Tools

Interqual/MCG (certification/experience)

Job description

Optum seeks an RN Utilization Manager to lead the DSNP clinical team in Washington, DC, coordinating HCBS reviews and care planning for members in home-based settings. You will partner with medical directors, providers, and plans to ensure high-quality utilization outcomes.

The role requires 3+ years in utilization management, strong leadership, and the ability to travel 25–50% within DC while maintaining clinical excellence and operational targets.