Top 14 Medstar family choice Jobs

Director Utilization Management MedStar Family Choice
MedStar Health —Washington, DC
- $120,702 - $238,222 a year
- Full-time
- Nursing
- RN License
- 5 years
6d
Field RN Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Management
- RN License
8d
Clinical Navigator - Part Time RN/PT/OT/SW
MedStar Health —Washington, DC
- $74,214 - $134,596 a year
- Part-time
- Acute care
- Nursing
- Surgery
RN Case Manager
MedStar Health —Washington, DC
- $89,065 - $162,801 a year
- Full-time
- Nursing
- Microsoft Excel
- RN License
Clinical Navigator - RN/PT/OT/SW
MedStar Health —Washington, DC
- $74,214 - $134,596 a year
- Full-time
- Acute care
- Nursing
- Surgery
Trainer Clinical Operations MedStar Family Choice DC
MedStar Health —Columbia, MD
- $89,065 - $162,801 a year
- Full-time
- Nursing
- RN License
- Mid-level
8d
Customer Service Representative
Medstar Medical Transportation —Tucson, AZ
- $15 - $17 an hour
- Full-time
- Entry level
- Health insurance
- Dental insurance
New Grad Nurse Residency Program (RN) October 2026 Cohort Medstar Georgetown University Hospital
MedStar Health —Washington, DC
- $41.78 an hour
- Full-time
- Nursing
- RN License
- BLS Certification
Job Title: Medical Biller (Medicaid & MCO - Behavioral Health)
Better Morning, Inc. —Washington, DC
- $25 - $28 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Critical & Intensive Care
Quick Apply
Part-time Clinical Dietitian
Sodexo —Baltimore, MD
- $67,405 - $87,230 a year
- 8 hour shift
- Hospital
- Inpatient
- Mid-level
- Free parking
- Paid holidays
Compliance Audit / Investigator - CCS / CPC / or CCA
MedStar Health —Washington, DC
- $65,062 - $117,291 a year
- Full-time
- Microsoft Outlook
- HIPAA
- Research
- Health insurance
Field Social Worker Clinician Case Manager
MedStar Health —Washington, DC
- $74,214 - $134,596 a year
- Full-time
- Nursing
- Management
- Licensed Clinical Social Worker
7d

More jobs to discover

Find similar jobs that you might be interested in.

Field RN Case Manager
MedStar Health —Washington, DC
MedStar Family Choice DC policies procedures training quality oversight and monitoring for staff and contracted field case managers will ensure consistency in…
$89,065 - $162,801 a year
8d
Field RN Case Manager - Workers' Compensation
Everest Care Management (ECM) —Dover, DE
Everest Care Management, Inc. is seeking Full-Time Field RN Case Managers in the Dover, DE area! Eight Paid Holidays including two floating holidays,…
$75,000 - $85,000 a year
Quick Apply

I want to receive the latest job alert for medstar family choice

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

medstar family choice jobs near

Director Utilization Management MedStar Family Choice

MedStar Health -
Washington, DC

Apply Now

Job Details

Full-time
$120,702 - $238,222 a year
6 days ago

Qualifications

RN License
Managed care organization experience
Team leadership
CMS
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 choice jobs

Director Utilization Management MedStar Family Choice

Field RN Case Manager

Clinical Navigator - Part Time RN/PT/OT/SW

RN Case Manager

Clinical Navigator - RN/PT/OT/SW

Trainer Clinical Operations MedStar Family Choice DC

Customer Service Representative

New Grad Nurse Residency Program (RN) October 2026 Cohort Medstar Georgetown University Hospital

Job Title: Medical Biller (Medicaid & MCO - Behavioral Health)

Part-time Clinical Dietitian

Compliance Audit / Investigator - CCS / CPC / or CCA

Field Social Worker Clinician Case Manager

More jobs to discover

I want to receive the latest job alert for medstar family choice

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected