ZipRecruiter

Log In

1

Contract Utilization Review Jobs in Baltimore, MD

Ampcus

Spec, Utilization Management

Baltimore, MD · On-site

Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist will analyze clinical information, contracts, mandates, medical policy, evidence-based published research ...

next page

Showing results 1-20

All JobsContract Utilization Review JobsContract Utilization Review Jobs in Baltimore, MD

Contract Utilization Review information

See Baltimore, MD salary details

$21

$42

$68

How much do contract utilization review jobs pay per hour?

As of Aug 29, 2026, the average hourly pay for contract utilization review in Baltimore, MD is $42.01, according to ZipRecruiter salary data. Most workers in this role earn between $33.22 and $48.27 per hour, depending on experience, location, and employer.

What is a contract utilization review?

A Contract Utilization Review job involves analyzing and evaluating the usage of contracts to ensure compliance, cost-effectiveness, and efficiency. Professionals in this role review contract terms, monitor vendor performance, and assess utilization data to optimize contract value. They may work in industries such as healthcare, government, or procurement, ensuring that agreements are being properly executed. The goal is to identify areas for improvement, reduce waste, and enhance operational efficiency.

What does a contract utilization review do?

A typical day in Contract Utilization Review involves reviewing patient medical records, ensuring adherence to payer contracts and regulatory standards, and communicating with healthcare providers to validate medical necessity of services. Professionals in this role often collaborate with clinical staff, case managers, and insurance representatives to resolve discrepancies or authorization issues. The work is detail-oriented and deadline-driven, making organizational skills vital. This dynamic position offers significant opportunities to learn more about healthcare regulations and may serve as a stepping stone toward more advanced roles in healthcare administration or compliance.

What are the key skills and qualifications needed to thrive in contract utilization review?

To thrive in Contract Utilization Review, you need a solid understanding of medical terminology, insurance policies, and contract compliance, often supported by a healthcare-related degree or certification in utilization management. Familiarity with utilization review software, electronic medical records (EMR), and knowledge of regulatory standards such as CMS guidelines is essential. Strong analytical thinking, attention to detail, and effective communication skills are crucial for collaborating with care teams and insurers. These abilities ensure reviews are accurate, contracts are properly administered, and patient care meets organizational and payer requirements.

What are the most commonly searched types of Utilization Review jobs in Baltimore, MD?

The most popular types of Utilization Review jobs in Baltimore, MD are:

What are popular job titles related to Contract Utilization Review jobs in Baltimore, MD?

For Contract Utilization Review jobs in Baltimore, MD, the most frequently searched job titles are:

What job categories do people searching Contract Utilization Review jobs in Baltimore, MD look for?

The top searched job categories for Contract Utilization Review jobs in Baltimore, MD are:

Contract Utilization Review jobs near you
Infographic showing various Contract Utilization Review job openings in Baltimore, MD as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 16% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $87,387 per year, or $42 per hour.

Spec, Utilization Management

Baltimore, MD • On-site

Ampcus
IT Services • 1 - 5K employees
Learn more about Ampcusexternal

Other

Re-posted 11 days ago

Job description

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.
Job Title: Spec, Utilization Management
Job Location: Baltimore, MD
Job Description:
Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care determination and benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist will analyze clinical information, contracts, mandates, medical policy, evidence-based published research, national accreditation and regulatory requirements to contribute to determination of appropriateness and authorization of clinical services both medical and behavioral health.
ESSENTIAL FUNCTIONS
  • Abstractor Primary functions:
    • 50% Determines medical necessity and appropriateness by referencing regulatory mandates, contracts, benefit information, Milliman Care Guidelines, Apollo Guidelines, ASAM (American Society of Addiction Medicine), Medicare Guidelines, Federal Employee Program and Policy Guidelines, Medical Policy, and other accepted medical/pharmaceutical references (i.e. FDA, National Comprehensive Cancer Network, Clinical trials.Gov, National Institute of Health, etc.) Follows NCQA Standards, Medical Policy, all guidelines and departmental SOPS to manage their member assignments. Understands all lines of business to include Commercial, FEP, and Medicare primary and secondary policies.
    • 30% Conducts research and analysis of pertinent diseases, treatments and emerging technologies, including high cost/high dollar services to support decisions and recommendations made to the medical directors. Collaborates with medical directors, sales and marketing, contracting, provider and member services to determine appropriate benefit application. Applies sound clinical knowledge and judgment throughout the review process. Coordinates non-par provider/facility case rate negotiations between Provider Contracting, providers and facilities. Follows member contracts to assist with benefit determination.
    • 20% Makes appropriate referrals and contacts as appropriate. Offers assistance to members and providers for alternative settings for care. Researches and presents educational topics related to cases, disease entities, treatment modalities to interdepartmental audiences.
Qualifications
  • Education Level: Bachelor's Degree
  • Education Details: Nursing
  • Experience: 5 years Clinical nursing experience, 2 years Care Management
  • Clinical Utilization Management expertise, regulatory compliance knowledge, experience in Guiding care platform
Licenses/Certifications
  • RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon Hire Req or
  • LPN - Licensed Practical Nurse - State Licensure
  • CNS-Clinical Nurse Specialist Pref
Preferred Qualifications
  • Working knowledge of managed care and health delivery systems.
  • Thorough knowledge of clinical guidelines, medical policies and accreditation and regulatory standards
  • Working knowledge of IT and Medical Management systems, familiarity with web-based software application environment and the ability to confidently use the internet as a resource.
Knowledge, Skills and Abilities (KSAs)
  • Effective written and interpersonal communication skills to engage with members, healthcare professionals, and internal colleagues, Proficient
  • Must have strong assessment skills with the ability to make rapid connection with Member telephonically., Proficient
  • Must be able to work effectively with large amounts of confidential member data and PHI, Expert
  • Must be able to prioritize workload during heavy workload periods, Proficient
  • Ability to multitask, prioritize and maintain a dynamic personal organization system that allows for flexibility, Advanced
  • Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and PowerPoint, Proficient
  • Excellent analytical and problem-solving skills to judge appropriateness of member services and treatments on a case by case basis, Proficient

Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities.
Ampcus logo

About Ampcus

Sourced by ZipRecruiter

Ampcus Inc. is a ISO 20000, ISO 27000, ISO 9001, CMMI DEV/3 SM and CMMI SVC/3 SM certified global provider of a broad range of Technology and Business consulting services. From strategy to execution, our disciplined yet flexible approach starts and ends with our clients. By listening hard and working harder, client goals become our goals. Their success is our satisfaction. It’s why our clients sleep well at night. We believe that the success of an engagement is determined by strong project management, as well as clear communication and mutual commitment working collaboratively. Our methodology begins with listening to the customer about their needs, then working with their team to gain a clear understanding of the requirements, while providing knowledge transfer of best practices for the organization.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Chantilly, VA, US

Year founded

2004

View All Ampcus Jobs

Apply