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Full Time Remote Utilization Review Jobs in Baltimore, MD

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

The ideal candidate will have previous experience performing utilization review within a healthcare payor organization. ESSENTIAL FUNCTIONS: * Utilize clinical expertise and critical thinking skills ...

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

The Clinical Navigator (RN) is responsible for utilization management and concurrent review of inpatient care to ensure members receive medically necessary services at the appropriate level of care.

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All JobsUtilization Review JobsFull Time Remote Utilization Review JobsFull Time Remote Utilization Review Jobs in Baltimore, MD

Full Time Remote Utilization Review information

See Baltimore, MD salary details

$21

$42

$68

How much do full time remote utilization review jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for full time remote 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 the difference between Full Time Remote Utilization Review vs Part Time Remote Utilization Review?

AspectFull Time Remote Utilization ReviewPart Time Remote Utilization Review
Work HoursTypically 40 hours/weekFewer hours, often less than 20/week
CertificationsRequired certifications like AAHAM or URAC often neededSame certifications as full-time, but may vary by employer
Work EnvironmentRemote, full-time employmentRemote, part-time engagement
Job ResponsibilitiesComplete utilization reviews, documentation, complianceSimilar responsibilities but on a reduced schedule

Full Time Remote Utilization Review involves working 40 hours weekly with comprehensive responsibilities, while Part Time Remote Utilization Review offers flexible, reduced hours with similar duties. Both roles require relevant certifications and are performed remotely, but differ mainly in hours and workload.

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

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

What are popular job titles related to Full Time Remote Utilization Review jobs in Baltimore, MD?

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

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The top searched job categories for Full Time Remote Utilization Review jobs in Baltimore, MD are:

Full Time Remote Utilization Review jobs near you

Utilization Review, RN Flex

University of Maryland Medical System

Towson, MD • Remote

Full-time

Posted 19 days ago

Job description

Job Requirements
  • Weekend only position. 
  • 4 - eight hour weekend shifts a month required. 
  • At least 1 major holiday required.
  • Only serious applicants should apply. 
  • Recent UR / MCG experience.
  • Most of the training will be remote however you will be required to start onsite

A Utilization Review (UR) Nurse is a registered nurse who bridges the gap between healthcare providers and insurance companies. They evaluate patient medical records to ensure treatments, procedures, and hospital stays are clinically necessary, cost-effective, and meet established insurance guidelines.

  • Medical Necessity Reviews: They verify that admissions, surgeries, and treatments are medically necessary by comparing patient charts to standardized, evidence-based guidelines like Milliman Care Guidelines (MCG) or InterQual.
  • Concurrent & Retrospective Reviews: They review ongoing hospital stays (concurrent) to authorize continuing care, and review charts after discharge (retrospective) to prevent claim denials and ensure accurate billing.
  • Insurance Liaison: They act as a go-between, submitting clinical data to insurance companies to secure prior authorizations and ongoing approvals so the hospital gets properly reimbursed.
  • Resource Optimization: They monitor the patient's progress to ensure they are in the appropriate level of care (e.g., observation vs. inpatient) and help coordinate discharges to lower levels of care.

Work Experience

Education

* 4 year/ Bachelor's degree in Nursing (Required)

Combination of relevant education and experience may be considered in lieu of degree.

Master's Degree in Nursing (Preferred)

Experience and Skills

Recent UR / MCG experience.

Required Skills: Strong Verbal Communications Skills, Strong Written Communications Skills, Excel Intermediate Level, PowerPoint - Intermediate Level, MS Word - Intermediate Level, Excellent Organizational Skills


Employment Type: OTHER

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