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Insurance Utilization Review Jobs in Baltimore, MD

Summit BHC

Utilization Assistant - Acute

Annapolis, MD · On-site

Assists in utilization reviews and insurance appeals. Responds to inquiries from patients, their families, and professional referral sources. Roles and Responsibilities: • Assists the admissions ...

Summit BHC

Utilization Assistant - Acute

Annapolis, MD · On-site

Assists in utilization reviews and insurance appeals. Responds to inquiries from patients, their families, and professional referral sources. Roles and Responsibilities: • Assists the admissions ...

Luminis Health

Utilization Management Nurse

Lanham, MD

$34 - $55/hr

Reviews the medical record by applying utilization review criteria, to assess clinical, financial ... Pay Range $34--$55 USD Luminis Health Benefits Overview: • Medical, Dental, and Vision Insurance ...

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 ...

GQR

RN - Case Manager

Baltimore, MD · On-site

$1.7K - $1.8K/wk

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

GQR Global Markets

RN - Case Manager

Baltimore, MD · On-site

$1.5K - $1.6K/wk

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

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Insurance Utilization Review information

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How much do insurance utilization review jobs pay per hour?

As of Aug 16, 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 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.

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 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 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, 74% Full Time, 20% Part Time, and 5% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $87,387 per year, or $42 per hour.

Utilization Assistant - Acute

Summit Behavioral Healthcare

Annapolis, MD • On-site

Other

Posted 5 days ago

Job description

Utilization Assistant - Acute

The Utilization Assistant provides support to all utilization review/management activities of the hospital to continuously improve the collection, reimbursement, coordination, and presentation of utilization review information. Works with insurance providers to obtain coverage for patients. Assists in utilization reviews and insurance appeals. Responds to inquiries from patients, their families, and professional referral sources.

Roles and Responsibilities:

  • Assists the admissions department with pre-certifications of care. Performs pre and post admission benefit verification with managed care organizations.
  • Reviews medical records of patients for appropriateness of level of care at admission and at intervals determined by documentation in medical record.
  • Conducts interactive and timely reviews with payers to ensure certification of care.
  • Maintains accurate documentation and files as it relates to utilization management.
  • Coordinates information and findings with the business office to help recognize or resolve possible payment problems.
  • Attends daily treatment team to discuss patient needs and ensure that all disciplines are aware of patient insurance status and needs.
  • Ensure that insurance benefits are verified in a timely manner.
  • Communicates any UR or Quality issues as noted in the chart to supervisor immediately to ensure timely resolution of problems.
  • Responds to telephone and Internet inquires.
  • Researches insurance company guidelines and uses admission and continuing stay criteria for coverage.

High School Diploma Required, Bachelor's Degree in social work, behavioral or mental health, or other related health field preferred. One or more years of direct clinical experience in a psychiatric or mental health setting preferred.

Highland Hospital offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Highland Hospital is an EOE.

Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.

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About Summit BHC

Sourced by ZipRecruiter

Summit BHC, based in Franklin, TN, USA, is a recognized leader in the field of addiction treatment and behavioral health care services. The company operates a nationwide network of treatment centers aimed at caring for individuals battling substance abuse and mental health disorders. Summit BHC was established with the mission to provide high-quality, addiction treatment and behavioral health services to those in need throughout the United States. With compassion, dignity, and respect as their core values, they endeavor to instill hope during the journey to recovery and beyond.

Industry

Health care and social assistance

Company size

501 - 1,000 Employees

Headquarters location

Franklin, TN, US

Year founded

2013

Social media

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