ZipRecruiter

Log In

1

Insurance Utilization Review Jobs in Baltimore, MD

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 ...

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 ...

previous page

Showing results 41-60

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

Insurance Utilization Review information

See Baltimore, MD salary details

$21

$42

$68

How much do insurance utilization review jobs pay per hour?

As of Sep 5, 2026, the average hourly pay for insurance 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 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 Baltimore, MD?

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

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

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

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

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

Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Baltimore, MD as of August 2026, with employment types broken down into 1% As Needed, 73% Full Time, 21% Part Time, and 5% Contract. Highlights an 84% Physical, 1% Hybrid, and 15% Remote job distribution, with an average salary of $87,383 per year, or $42 per hour.

Utilization Management Denials Nurse

Luminis Health

Annapolis, MD

$34 - $55/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 10 days ago

Luminis Health rating

7.9

Company rating: 7.9 out of 10

Based on 54 frontline employees who took The Breakroom Quiz

110th of 898 rated healthcare providers

Job description

Position Objective:  Conducts concurrent and retrospective chart review for clinical, financial, and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment.  

Essential Job Duties:

1. Chart Review:

Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource utilization; enters clinical review in EPIC; maintains close communication with external reviews, care coordinators, and providers; reconciles and records days authorized in EPIC

2. Denial Management:

Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken to avoid denial;  assists Care Coordinator in communicating with the patient denied hospital days with work toward resolution and discharge.

3. Care Coordination:

Collaborates with the Care Coordinator to achieve optimal and efficient patient outcomes while decreasing length of stay, avoidable delays and denied days; utilizes Physician Advisor and administrative personnel for unresolved issues; identifies opportunities for expedited appeals and collaborates with the care coordinator and Physician Advisor to resolve payer issues.

4.  Process improvement initiatives

Participates in nursing unit and department clinical outcome projects as well as process improvement initiatives of care management.

Educational/Experience Requirements:

  • Bachelor’s of Science in Nursing or Associate’s degree in Nursing with equivalent experience.  BSN must be achieved within 5 years of start date in the role.  
  • Three years of clinical nursing in an acute care hospital setting.

RequiredLicense/Certifications:

  • Current RN license from Maryland Board of Nursing.

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will be exposed to blood-borne pathogens.

Physical Demands -

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.

Pay Range
$34—$55 USD

Luminis Health Benefits Overview:
•    Medical, Dental, and Vision Insurance
•    Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
•    Paid Time Off
•    Tuition Assistance Benefits
•    Employee Referral Bonus Program
•    Paid Holidays, Disability, and Life/AD&D for full-time employees
•    Wellness Programs
•    Employee Assistance Programs and more
*Benefit offerings based on employment status

Opt-in for text notifications!
Luminis Health's two-way SMS texting platform lets you receive notifications and messages from our Talent Acquisition team directly on your phone.
To enable this feature, select "yes" when asked to "opt-in to receive text messages" and to "Receive updates from a recruiter about this job via SMS" when completing your application. Once you are opted in, you can easily opt-out at any time. 
Standard text messaging rates may apply based on the candidate's mobile carrier plan. Luminis Health is not responsible for any charges incurred by the recipient. Candidates are encouraged to review their mobile carrier's plan for applicable text messaging rates and usage charges.


What Luminis Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply