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Insurance Utilization Review Jobs in Maryland (NOW HIRING)

Mercy Medical Center

Case Manager

Baltimore, MD · On-site

$66.46/hr

Utilization review skills using MCG preferred Min USD $36.92/Hr. Max USD $66.46/Hr. Salary ... Discounts on auto & home insurance and Verizon plans * Mercy's Rewards & Recognition Program ...

Mercy Medical Center

Case Manager

Baltimore, MD · On-site

$66.46/hr

Utilization review skills using MCG preferred Min USD $36.92/Hr. Max USD $66.46/Hr. Salary ... Discounts on auto & home insurance and Verizon plans * Mercy's Rewards & Recognition Program ...

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

The ideal candidate will have previous experience performing utilization review within a healthcare ... health insurance operations (e.g. networks, eligibility, benefits). * Must be able to meet ...

CareFirst, Inc.

Clinical Navigator (Remote)

Baltimore, MD · On-site

$72 - $144/hr

The ideal candidate will have previous experience performing utilization review within a healthcare ... health insurance operations (e.g. networks, eligibility, benefits). * Must be able to meet ...

GQR Healthcare

Travel Case Manager RN

Randallstown, MD · On-site

$1.6K - $1.7K/wk

Travel Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...

New

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

The Clinical Navigator (RN) is responsible for utilization management and concurrent review of ... health insurance operations (e.g. networks, eligibility, benefits). * Must be able to meet ...

ATC Travelers A

Case Manager

Baltimore, MD · On-site

$19.75 - $25.50/hr

Conducting utilization reviews to ensure that patient stays meet medical necessity criteria as defined by insurance providers and regulatory agencies. * Identifying and mitigating barriers to timely ...

ATC Travelers A

Case Manager

Baltimore, MD · On-site

$19.75 - $25.50/hr

Conducting utilization reviews to ensure that patient stays meet medical necessity criteria as defined by insurance providers and regulatory agencies. * Identifying and mitigating barriers to timely ...

ATC Travelers A

Case Manager

Baltimore, MD · On-site

$19.75 - $25.50/hr

Conducting utilization reviews to ensure that patient stays meet medical necessity criteria as defined by insurance providers and regulatory agencies. * Identifying and mitigating barriers to timely ...

ATC Travelers A

Case Manager

Baltimore, MD · On-site

$19.75 - $25.50/hr

Conducting utilization reviews to ensure that patient stays meet medical necessity criteria as defined by insurance providers and regulatory agencies. * Identifying and mitigating barriers to timely ...

ATC Travelers A

Case Manager

Baltimore, MD · On-site

$19.75 - $25.50/hr

Conducting utilization reviews to ensure that patient stays meet medical necessity criteria as defined by insurance providers and regulatory agencies. * Identifying and mitigating barriers to timely ...

Mercy Medical Center, Inc.

Case Manager

Baltimore, MD · On-site

$83 - $138/hr

Utilization review skills using MCG preferred Min USD $36.92/Hr. Max USD $66.46/Hr. Salary ... Discounts on auto & home insurance and Verizon plans * Mercy's Rewards & Recognition Program ...

TidalHealth

Authorization Specialist

Berlin, MD · On-site

$22.14 - $34.32/hr

... Utilization RNs, physician advisors, insurance companies, finance, patients, providers, and ... related to utilization review, discharge planning, PCP appointments, regulatory paperwork ...

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Showing results 21-40

All JobsInsurance Utilization Review JobsInsurance Utilization Review Jobs in Maryland

Insurance Utilization Review information

See Maryland salary details

$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.

Case Manager

Mercy Medical Center

Baltimore, MD • On-site

$66.46/hr

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 7 days ago

Job description

Summary

Join Our Team at Mercy Medical Center – Now Hiring an RN Case Manager!

Mercy Medical Center is honored to be recognized by Newsweek as one of America's Most Trustworthy Companies for three consecutive years (2023–2025) and as one of America's Greatest Workplaces for Women in 2025. Additionally, we are proud to be a multi-time recipient of Forbes' America's Best Midsize Employers award, most recently in 2025.

As a hospital founded by the Sisters of Mercy, we offer a supportive and empowering environment where dedicated medical professionals thrive. If you're passionate about making a meaningful impact through your work and contributing to a mission of compassionate care, we invite you to apply today and join our Mercy family.


Responsibilities

The RN Case Manager applies case management strategies to assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual's healthcare needs, through communication and the use of available resources to promote quality, cost effective outcomes. The RN Case Manager, in close collaboration with the physician, will be responsible for the in-patient length of stay (LOS), denied days, resources utilization and will oversee the discharge planning process.

The RN Case Manager responsibilities include assessing clients needs, developing individualized care plans, coordinating with physicians, social workers and ancillary staff, and advocating for clients' rights and access to resources. They monitor client progress, maintain detailed records, facilitate communication between all parties, and provide support and crisis intervention when necessary. The RN Case Manager, in close collaboration with the physician, will be responsible for the in-patient length of stay (LOS), denied days, provide daily utilization reviews and will oversee the discharge planning process.


Requirements
  • Must possess a degree in Nursing
  • Valid RN License
  • 3 years in the clinical setting; Medical/Surgical experience preferred
  • Managed care experience preferred
  • Case management experience preferred
  • Utilization review skills using MCG preferred

Min
USD $36.92/Hr.
Max
USD $66.46/Hr.
Salary Information
Compensation decisions are made in alignment with internal equity, role scope, and market data to ensure fair and consistent pay practices. Most new hires are typically placed within the lower to mid-portion of the range; offers above that level are reserved for candidates with advanced or highly specialized qualifications.
Benefits

Benefits Eligibility is based on your scheduled FTE status and Job Category

  • Competitive health, prescription, vision and dental benefits & wellness credit for eligible employees
  • 403(b) retirement plan with generous company match and “catch up” provision
  • Paid Time Off (PTO) & company paid holidays
  • Tuition reimbursement
  • Mental Health resources and other employee related wellness opportunities through our Employee Assistance Program
  • Employer paid Short & Long Term Disability benefits for eligible employees
  • Voluntary Benefits
  • Discounts on auto & home insurance and Verizon plans
  • Mercy’s Rewards & Recognition Program rewarding employees for going above and beyond in living Mercy’s Mission and Values

EEO Statement

Mercy Health Services is sponsored by the Sisters of Mercy. We are an Equal Opportunity Employer (EEO) recruiting talent for Mercy Health Services, which serves the greater Baltimore Metro and surrounding Maryland areas.

Qualifications:
  • Must possess a degree in Nursing
  • Valid RN License
  • 3 years in the clinical setting; Medical/Surgical experience preferred
  • Managed care experience preferred
  • Case management experience preferred
  • Utilization review skills using MCG preferred
Education:UNAVAILABLEEmployment Type: FULL_TIME

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