Strategic Director of Utilization Management

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

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.