Overview MedStar Health is looking for a System Director of Utilization Management.
The System Director of Utilization Management is responsible for overseeing utilization review operations across a defined group of hospitals within the designated region (Maryland or the District of Columbia). The role requires deep knowledge of regulatory requirements for the region and partnership with system ACM leaders to operationalize the strategic vision. The position ensures consistent application of evidence-based review practices with oversight and performance management of UR RN teams, drives performance aligned with regulatory and payor expectations, and supports delivery of high-quality care, operational efficiencies, reduction in avoidable utilization, and collaboration with clinical and operational stakeholders.
Responsibilities Oversee utilization review operations across a defined group of hospitals within the designated region (Maryland or the District of Columbia).
Possess deep knowledge and expertise of regional regulatory requirements.
Operationalize the strategic vision in partnership with system ACM leaders.
Ensure consistent application of evidence-based review practices with oversight and performance management of UR RN teams.
Drive performance aligned with regulatory and payor expectations to deliver high-quality care, achieve operational efficiencies, and reduce avoidable utilization through collaboration with clinical and operational stakeholders.
Qualifications MSN required.
Active DC or MD RN license required.
5-7 years of experience in Utilization Management with 3-5 years in Utilization Management leadership required.
3-5 years of experience in acute care bedside nursing required.
Compensation This position has a hiring range of $139,276 - $278,241.
Seniority level Director
Employment type Full-time
Industries Hospitals and Health Care