Top 466 Medstar family Jobs

Director Utilization Management MedStar Family Choice
MedStar Health —Washington, DC
- $120,702 - $238,222 a year
- Full-time
- Nursing
- RN License
- 5 years
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Daytime Hospitalist - MedStar Washington Hospital Center
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MedStar Health —Washington, DC
- $255,000 - $285,000 a year
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Research Specialist 3 - Medical Center
Georgetown University —Washington, DC
- $47,586.00 - $87,558.13 a year
- Full-time
- Mid-level
- University
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- Disability insurance
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Nuclear Medical Technologist
MedStar Health —Washington, DC
- $35.68 - $64.71 an hour
- PRN
- Anatomy knowledge
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- BLS Certification
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- Tuition reimbursement
Registered Nurse (RN) Burn Trauma ICU
MedStar Health —Washington, DC
- $41.37 - $66.92 an hour
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Interventional Radiology Technologist
MedStar Health —Baltimore, MD
- $35.68 - $78.27 an hour
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- Inventory control
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- Tuition reimbursement
CT Technologist
MedStar Health —Washington, DC
- $39.25 - $64.71 an hour
- Part-time
- CPR Certification
- Anatomy knowledge
- Hospital
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- Tuition reimbursement
Mammography Technologist - $10,000 Sign-on Bonus
MedStar Health —Washington, DC
- $35.68 - $64.71 an hour
- Full-time
- CPR Certification
- Anatomy knowledge
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- Health insurance
- Tuition reimbursement
CT Technologist
MedStar Health —Baltimore, MD
- $35.68 - $58.84 an hour
- Multiple hires
- CPR Certification
- Anatomy knowledge
- Hospital
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- Tuition reimbursement
Radiation Therapist - $12,500 Sign-on Bonus
MedStar Health —Washington, DC
- $35.68 - $64.71 an hour
- Full-time
- Hospital
- BLS Certification
- Mid-level
- Continuing education credits
Daytime Hospitalist Physician - MedStar St. Mary's Hospital
MedStar Health —Leonardtown, MD
- $275,000 - $305,000 a year
- Full-time
- Medicine
- Internal Medicine
- Inpatient
- 403(b) matching
- Health insurance
Neonatologist - Level III NICU - MedStar Franklin Square Hospital
MedStar Health —Baltimore, MD
- $280,000 - $300,000 a year
- Weekends as needed
- Medicine
- BLS Certification
- Critical & Intensive Care
- 403(b) matching
- Health insurance
MRI Technologist - $10,000 Sign-on Bonus
MedStar Health —Washington, DC
- $35.68 - $64.71 an hour
- Weekends as needed
- Anatomy knowledge
- Inventory control
- BLS Certification
- Health insurance
- Tuition reimbursement
Sr Radiation Therapist - $12,500 Sign-on Bonus
MedStar Health —Washington, DC
- $42.82 - $78.27 an hour
- Full-time
- Bachelor of Science
- Mid-level
- Bachelor's degree
Registered Nurse (RN) Cardiac Telemetry
MedStar Health —Baltimore, MD
- $36.50 - $60.34 an hour
- 12 hour shift
- Nursing
- RN License
- Hospital
- Free parking
- Relocation assistance
Registered Nurse (RN) - ICU
MedStar Health —Leonardtown, MD
- $37.50 - $54.92 an hour
- Full-time
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- RN License
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Radiology Technologist
MedStar Health —Washington, DC
- $29.73 - $53.49 an hour
- Full-time
- Vital signs
- BLS Certification
- Urgent Care
Registered Nurse RN Neurosciences ICU
MedStar Health —Washington, DC
- $42.00 - $69.42 an hour
- Full-time
- Nursing
- RN License
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Pediatric Anesthesiologist
MedStar Health —Washington, DC
- $490,000 a year
- Full-time
- Inpatient
- Neurology
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- Paid holidays
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Director Utilization Management MedStar Family Choice

MedStar Health -
Washington, DC

Apply Now

Job Details

Full-time
$120,702 - $238,222 a year

Benefits

Health insurance

Qualifications

RN License
Managed care organization experience
Team leadership
Change management
Medicaid health insurance
CMS regulatory compliance
Bachelor's degree
InterQual
Bachelor's degree in nursing
Financial acumen
Data analytics technologies
Senior leadership

Full Job Description

About this Job: General Summary of Position
The Director of Utilization Management (UM) provides strategic and operational leadership for the health plan's centralized utilization management function across both plans. This role ensures appropriate evidence-based utilization of services while maintaining regulatory compliance improving quality outcomes and driving cost-effective delivery. Under a centralized clinical operation model the Director aligns UM process across plans standardizes workflows optimizes technology and integrates closely with Case Management Pharmacy Quality and Provider Relations to support enterprise-wide performance goals.

Primary Duties and Responsibilities

Leads enterprise-wide utilization management strategy across all health plans under a centralized clinical operation model.
Standardizes UM policies workflows and clinical criteria application to ensure consistency and scalability across markets.
Oversees prior authorization concurrent review retrospective review to ensure timely and compliant determinations.
Ensures compliance with state Medicaid NCQA CMS and contractual requirements including turnaround time standards.
Partners with medical directors to ensure appropriate clinical decision-making and consistent application of medical necessity criteria.
Develops and monitors UM performance dashboards including denial rates overturn rates length of stay and turnaround times.
Drives medical expense management initiatives by identifying utilization trends and implementing targeted interventions.
Collaborates with Case Management leadership to ensure seamless transitions between UM and care coordination functions.
Partners with pharmacy leadership to align utilization controls on high-cost drugs and specialty therapies.
Oversees hospital utilization management including inpatient admission appropriateness DRG optimization and reduction strategies.
Identifies and implements process improvement initiatives to increase operational efficiency and reduce variability.
Prepares for a lead regulatory audits accreditation reviews and corrective action plans related to UM functions.
Monitors and ensures compliance with evidence-based clinical criteria tools (e.g. InterQual ASAM) and internal policies.
Leads workforce planning and staffing models to ensure appropriate caseload distribution and productivity standards.
Supervises and develops UM managers and supervisors including performance evaluations and professional development.
Collaborates with Finance and Actuarial team to analyze utilization trends cost drivers and forecast medical expense impact.
Supports value-based payment models and alternative payment initiatives by aligning UM process with performance metrics.
Develops escalation and peer review process to manage complex or high-risk clinical determinations.
Ensures culturally competent and member- center decision-making balancing access quality and cost stewardship.
Provides executive-level reporting and strategic recommendation to the VP of Clinical Operations and senior leadership

Minimal Qualifications
Education

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

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure in MD/DC Upon Hire required

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
Change management expertise
Excellent executive communication skills.

This position has a hiring range of : USD $120,702.00 - USD $238,222.00 /Yr.

Apply Now

Refine Your Search

medstar family jobs

Director Utilization Management MedStar Family Choice

Daytime Hospitalist - MedStar Washington Hospital Center

Daytime Hospitalist - MedStar Georgetown University Hospital

Research Specialist 3 - Medical Center

Nuclear Medical Technologist

Registered Nurse (RN) Burn Trauma ICU

Interventional Radiology Technologist

CT Technologist

Mammography Technologist - $10,000 Sign-on Bonus

CT Technologist

Radiation Therapist - $12,500 Sign-on Bonus

Daytime Hospitalist Physician - MedStar St. Mary's Hospital

Neonatologist - Level III NICU - MedStar Franklin Square Hospital

MRI Technologist - $10,000 Sign-on Bonus

Sr Radiation Therapist - $12,500 Sign-on Bonus

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Registered Nurse (RN) - ICU

Radiology Technologist

Registered Nurse RN Neurosciences ICU

Pediatric Anesthesiologist

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