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Insurance Utilization Review Jobs in Maryland (NOW HIRING)

Commence

Clinical Medical Director

Annapolis Junction, MD · On-site

$275K - $375K/yr

Background in health insurance, utilization review, or healthcare claims processing, including familiarity with medical necessity criteria and coverage determination standards. * Demonstrated ...

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All JobsInsurance Utilization Review JobsInsurance Utilization Review Jobs in Maryland

Insurance Utilization Review information

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$20

$41

$66

How much do insurance utilization review jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for insurance utilization review in Maryland is $41.04, according to ZipRecruiter salary data. Most workers in this role earn between $32.45 and $47.12 per hour, depending on experience, location, and employer.

What is an insurance utilization review?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

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

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What are the most common challenges faced by insurance utilization review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

How do I get into an insurance utilization review?

To become an insurance utilization review specialist, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of insurance policies and medical terminology. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or similar credentials can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and insurance software systems.

Is insurance utilization review a stressful job?

Insurance utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. Reviewers often handle complex cases and must balance policy guidelines with patient needs, which can contribute to job pressure. However, the level of stress varies depending on workload, work environment, and individual coping skills.

What are the most commonly searched types of Insurance Utilization Review jobs in Maryland?

The most popular types of Insurance Utilization Review jobs in Maryland are:

What are popular job titles related to Insurance Utilization Review jobs in Maryland?

For Insurance Utilization Review jobs in Maryland, the most frequently searched job titles are:

What job categories do people searching Insurance Utilization Review jobs in Maryland look for?

The top searched job categories for Insurance Utilization Review jobs in Maryland are:

What cities in Maryland are hiring for Insurance Utilization Review jobs?

Cities in Maryland with the most Insurance Utilization Review job openings:

Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Maryland as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 18% Part Time, and 4% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $85,356 per year, or $41 per hour.

Utilization Review Nurse (Full-Time)

Greater Baltimore Medical Center Healthcare

Towson, MD • On-site

Full-time

Posted 22 days ago

Key responsibilities

  • Reviews electronic medical records during the pre-admission process to determine appropriate patient status.

  • Develops initial admission reviews and provides timely status recommendations to admitting providers.

  • Assists with discharge planning and coordinates services with managed care companies and third-party payers.

Job description

Under general supervision, provides consultative support to the admitting teams concerning patient status determinations and utilization of hospital resources facilitating quality, cost-effective patient outcomes for patients requiring hospital services. Works collaboratively with interdisciplinary staff internal and external to the organization facilitating appropriate status determinations through the utilization review process supporting quality, cost-effective patient outcomes. Responsible for analyzing clinical information and performing timely initial and concurrent reviews using InterQual screening software to identify appropriate medical necessity, length of stay, and level of care based upon evidence based clinical guidelines
Education:
Bachelor of Science in Nursing (BSN) OR Associate of Science in Nursing and currently enrolled in a BSN program with an expected graduation date within three (3) years.
Licensure, Certifications:
  • Current state of Maryland Registered Nurse license
  • Bachelor of Science in Nursing (BSN)
  • Certification in Utilization Management and/or Care Management highly desired.

Experience:
Five (5) years diversified, progressive experience in acute care and/or other settings within the continuum required.
Two (2) years of Utilization Review and Case Management experience which includes utilization review processes and discharge planning, and working with Re-Admission Initiatives preferred.
Skills:
• Advanced knowledge of InterQual and/or MCG admission criteria
• Knowledge of healthcare regulatory standards
• Advanced skill in using computer software
• Advanced skill in oral and written communication
• Advanced skill in critical thinking
• Ability to work independently and resolve complex problems
• Ability to remain calm under pressure and intense time constraints
• Ability to assess discharge needs for patients
• Strong analytical and problem-solving skills
• Strong interpersonal communication and influencing skills necessary to interact effectively with physicians, payers, regulatory agencies, staff, and other health professional
• Strong organizational and time management skills
• Ability to operate independently and balance multiple priorities
• Proficiency in electronic medical record review
Principal Duties and Responsibilities:
  • Reviews available electronic medical records during the pre-admission process to determine appropriate patient status, optimizing correct patient classification and corresponding payer notifications.
  • Reviews the appropriateness of admission and continued stay criteria for a defined group of patients
  • Develops initial admission reviews for patients requiring hospital services and provides timely status recommendations to admitting providers a concurrent stay and/or discharge plan of care in accordance with departmental and payer clinical guidelines.
  • Maintains a working knowledge of contractual and clinical criteria guidelines. Coordinates services with managed care companies and other third party payers. Discusses on-site reviewer issues with payer, either via the telephone or in person
  • Assures timely utilization compliance with all payers who require authorizations and clinical submission. Demonstrates knowledge of reimbursement mechanisms. Considers patient's financial resources for meeting healthcare needs (insurance reimbursement, managed care plans, entitlement programs, and personal resources).
  • Participates as an active partner with physicians and interdisciplinary teams, providing education ancillary, and nursing staffregarding admission decisions including status determinations, financial and clinical outcomes, and documentation requirements and standards.
  • Maintains current knowledge on all regulatory changes that affect care delivery or reimbursement of acute care services. Uses
  • knowledge of national and local coverage determinations to appropriately advise physicians.
  • Identifies system obstacles that affect patient outcomes and participates in interdisciplinary decisions and care of the patient. consults with interdisciplinary team members to address problems, and makes recommendations to problem solve.
  • Assists with discharge planning, by preventing un-necessary hospital utilization, assist in the appropriate return of and placement of patients to post acute care, community based care and appropriate alternate levels of care.
  • Demonstrates mastery in InterQual level of care guidelines. Possesses proficiency in utilization review systems, clinical support systems, and business support applications.
  • Promotes use of evidence-based protocols to influence high quality and cost-effective care.
  • Escalates clinically and financially complex cases to leadership, offering possible solutions through discussion and feedback. Engages regularly in formal and informal dialogue about quality; directly addressing concerns and promoting continuous improvement.
  • Performs concurrent reviews and additional duties as assigned.

All roles must demonstrate GBMC Values:
Respect
I will treat everyone with courtesy. I will foster a healing environment.
  • Treats others with fairness, kindness, and respect for personal dignity and privacy
  • Listens and responds appropriately to others' needs, feelings, and capabilities

Excellence
I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.
  • Meets and/or exceeds customer expectations
  • Actively pursues learning and self-development
  • Pays attention to detail; follows through

Accountability
I will be professional in the way I act, look and speak. I will take ownership to solve problems.
  • Sets a positive, professional example for others
  • Takes ownership of problems and does what is needed to solve them
  • Appropriately plans and utilizes required resources for various job duties
  • Reports to work regularly and on time

Teamwork
I will be engaged and collaborative. I will keep people informed.
  • Works cooperatively and collaboratively with others for the success of the team
  • Addresses and resolves conflict in a positive way
  • Seeks out the ideas of others to reach the best solutions
  • Acknowledges and celebrates the contribution of others

Ethical Behavior
I will always act with honesty and integrity. I will protect the patient.
  • Demonstrates honesty, integrity and good judgment
  • Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers

Results
I will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals.
  • Embraces change and improvement in the work environment
  • Continuously seeks to improve the quality of products/services
  • Displays flexibility in dealing with new situations or obstacles
  • Achieves results on time by focusing on priorities and manages time efficiently

Pay Range
$68,281.18 - $110,274.20
Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.
Equal Employment Opportunity
GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

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