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Insurance Utilization Reviewer Jobs in Maryland (NOW HIRING)

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

Annapolis, MD

$34 - $55/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

Luminis Health

Utilization Management Nurse

Lanham, MD

$34 - $55/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

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 ...

Zimmerman Associates, Inc.

$24.13/hr

At least 2 years of experience in Utilization Management, Referral Management, Authorization ... Processing/Insurance Referral * U.S. Citizenship required, with the ability to obtain a Public ...

Zimmerman Associates, Inc.

$23.56/hr

At least 2 years of experience in Utilization Management, Referral Management, Authorization ... Processing/Insurance Referral * U.S. Citizenship required, with the ability to obtain a Public ...

TEKsystems

Insurance Verification Coordinator

Annapolis, MD · Remote

$17.50 - $26/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Insurance Verification Coordinator Location: Remote (Must reside in Maryland, Pennsylvania ... utilization review, and clinical departments to secure required approvals. • Notify patients and ...

GQR

RN - Case Manager

Baltimore, MD · On-site

$1.7K - $1.8K/wk

  • Medical

  • Dental

  • Vision

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

  • Medical

  • Dental

  • Vision

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 Reviewer information

What are the key skills and qualifications needed to thrive as an insurance utilization reviewer, and why are they important?

To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.

What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?

AspectInsurance Utilization ReviewerInsurance Claims Processor
Primary RoleReview medical necessity and appropriateness of services for insurance coverageProcess and review insurance claims for payment and accuracy
Required CredentialsOften requires healthcare or insurance certifications, such as RHIT or CPCTypically requires claims processing or insurance certifications, like CPC or CPC-H
Work EnvironmentHealthcare settings, insurance companies, or third-party administratorsInsurance companies, healthcare providers, or claims processing centers
Industry UsageCommonly employed in health insurance and managed careWidely used across health, auto, and property insurance sectors

The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.

What are some common challenges faced by insurance utilization reviewers, and how can they be addressed?

One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.

What is an insurance utilization reviewer?

Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.

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

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

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

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

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

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

Insurance Utilization Reviewer jobs near you
Infographic showing various Insurance Utilization Reviewer job openings in Maryland as of August 2026, with employment types broken down into 90% Full Time, 6% Part Time, and 4% Contract. Highlights an 90% In-person, 2% Hybrid, and 8% Remote job distribution.

Utilization Assistant - Acute

Summit BHC

Annapolis, MD • On-site

Other

Posted 4 days ago

Job description

Utilization Assistant - Acute | Highland Hospital | Annapolis, Maryland
About the Job:
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.
Why Highland Hospital?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.

Summit BHC logo

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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