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 ...
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 ...
Baltimore, MD · On-site
$36.92/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 ...
Baltimore, MD · On-site
$36.92/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 ...
Linthicum Heights, MD · On-site
$18 - $24/hr
Collaborates with vendors, insurance carriers, and internal departments to monitor appeal status ... Three (3) years of experience in denial and appeals processing, utilization review, collections, or ...
Linthicum Heights, MD · On-site
$18 - $24/hr
Collaborates with vendors, insurance carriers, and internal departments to monitor appeal status ... Three (3) years of experience in denial and appeals processing, utilization review, collections, or ...
... the utilization review process. Essential Job Duties: Reasonable accommodations may be made to ... Obtains insurance authorization and submits timely clinical information and feedback to the Payors ...
... the utilization review process. Essential Job Duties: Reasonable accommodations may be made to ... Obtains insurance authorization and submits timely clinical information and feedback to the Payors ...
Prince Frederick, MD · On-site
$115 - $150/hr
Ensure impeccable and timely client documentation, collaborating with Utilization Review as ... Medical Insurance * Dental * Vision * Accident * Critical Illness * Hospital Indemnity * Voluntary ...
Prince Frederick, MD · On-site
$115 - $150/hr
Ensure impeccable and timely client documentation, collaborating with Utilization Review as ... Medical Insurance * Dental * Vision * Accident * Critical Illness * Hospital Indemnity * Voluntary ...
Baltimore, MD · On-site
$192 - $356/hr
... utilization review with strategic population health, value-based care, and provider-performance ... insurance, supplemental life insurance, employee assistance program, paid holidays, tuition ...
Baltimore, MD · On-site
$192 - $356/hr
... utilization review with strategic population health, value-based care, and provider-performance ... insurance, supplemental life insurance, employee assistance program, paid holidays, tuition ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Knowledge of medical and utilization review techniques. * Required Licenses and Certifications ... Health insurance industry experience * Experience in INPATIENT Rehabilitation * Medicare policy ...
Participates in Quality Assurance and Utilization Review activities, as directed * Empowers ... Health, dental, vision, and life insurance * 401(k) savings plan * Awards and recognition programs
Participates in Quality Assurance and Utilization Review activities, as directed * Empowers ... Health, dental, vision, and life insurance * 401(k) savings plan * Awards and recognition programs
Randallstown, MD · On-site
$40.12 - $62.19/hr
This requirement will be lifted for LBH candidates employed as a Utilization Review Nurse, Clinical ... life and disability insurance Tuition reimbursement toward advanced degrees and specialty ...
Randallstown, MD · On-site
$40.12 - $62.19/hr
This requirement will be lifted for LBH candidates employed as a Utilization Review Nurse, Clinical ... life and disability insurance Tuition reimbursement toward advanced degrees and specialty ...
$20.76 - $24.96
2% of jobs
$24.96 - $29.16
9% of jobs
$32.04 is the 25th percentile. Wages below this are outliers.
$29.16 - $33.36
21% of jobs
The median wage is $36.76 / hr.
$33.36 - $37.56
23% of jobs
$37.56 - $41.76
13% of jobs
$45.03 is the 75th percentile. Wages above this are outliers.
$41.76 - $45.96
10% of jobs
$45.96 - $50.16
8% of jobs
$50.16 - $54.36
5% of jobs
$54.36 - $58.56
5% of jobs
$58.56 - $62.76
2% of jobs
$62.76 - $66.96
2% of jobs
$20
$41
$66
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.
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.
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.
The most popular types of Insurance Utilization Review jobs in Maryland are:
For Insurance Utilization Review jobs in Maryland, the most frequently searched job titles are:
The top searched job categories for Insurance Utilization Review jobs in Maryland are:
Cities in Maryland with the most Insurance Utilization Review job openings:
$22.14 - $34.32/hr
Full-time
Medical, Dental, Vision, Life, Retirement, PTO
Posted 11 days ago
6.3
Based on 61 frontline employees who took The Breakroom Quiz
669th of 898 rated healthcare providers
Why work at TidalHealth?
Join a triple 'A' rated team where clinical excellence meets a coastal lifestyle. At TidalHealth, you’ll be part of an award-winning network spanning Maryland and Delaware, recognized by the Leapfrog Hospital Safety Guide for our unwavering commitment to patient care. Whether your expertise lies in specialized clinical fields like neurosurgery, academic mentorship through our graduate medical programs, or the critical professional and support roles that keep our network thriving, we provide the tools and tuition assistance you need to excel.
Authorization Specialist Position Summary
The Authorization Specialist is responsible and accountable for monitoring and submitting all insurance authorizations including but not limited to; prior service, surgical, acute hospital, and post-acute care authorizations, that may include rehabilitation, transportation, medication, durable medical equipment, and home service authorizations that align with medical necessity policies and regulatory requirements for TidalHealth. The Authorization Specialist works collaboratively with Case Managers, Utilization RNs, physician advisors, insurance companies, finance, patients, providers, and authorization process stakeholders, to reduce length of stay, ensure fiscal responsibility, appropriate use of benefits, and streamlining the discharge process. They will also be responsible for maintaining and following up on non-clinical administrative tasks related to utilization review, discharge planning, PCP appointments, regulatory paperwork, invoicing, prior authorizations, benefit verification preservice review, healthcare claims inquiry, appeal/denial tracking, and case documentation.
Authorization Specialist Position Requirements
Education:
Experience:
Schedule:
Authorization Specialist Benefits:
Benefits: We provide a robust benefits suite for our eligible team members (36+ hours for 12-hour shifts; 37.5+ hours for standard shifts):
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Health care and social assistance
51 - 200 Employees
Salisbury, MD, US
1897
