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Insurance Utilization Reviewer Jobs in Crofton, 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 ...

Gaudenzia

Clinical Review Clinician

Washington, DC · On-site

$85K/yr

We are seeking master's level, licensed, clinician, with documented experience in utilization ... insurance requirements, and relevant treatment guidelines * Ensure accurate, up-to-date records ...

New

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 ...

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All JobsInsurance Utilization Reviewer JobsInsurance Utilization Reviewer Jobs in Crofton, MD

Insurance Utilization Reviewer information

See Crofton, MD salary details

$31.4K

$38.4K

$44.5K

How much do insurance utilization reviewer jobs pay per year?

As of Aug 12, 2026, the average yearly pay for insurance utilization reviewer in Crofton, MD is $38,422.00, according to ZipRecruiter salary data. Most workers in this role earn between $34,400.00 and $42,500.00 per year, depending on experience, location, and employer.

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 Crofton, MD? For Insurance Utilization Reviewer jobs in Crofton, MD, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Reviewer jobs in Crofton, MD look for? The top searched job categories for Insurance Utilization Reviewer jobs in Crofton, MD are:
What cities near Crofton, MD are hiring for Insurance Utilization Reviewer jobs? Cities near Crofton, MD with the most Insurance Utilization Reviewer job openings:
Insurance Utilization Reviewer jobs near you

Utilization Management CoordinatorNE

University of Maryland Medical System

Glen Burnie, MD • On-site

$406K/yr

Part-time

Posted 25 days ago

Job description

Job Requirements
Company Description
Experience the highest level of appreciation at UM Baltimore Washington Medical Center - named Top Workplace in the Baltimore area by The Baltimore Sun two years in a row (2019 & 2020); Top Workplace in the USA for 2021! As part of the acclaimed University of Maryland Medical System, our facility is one of three ANCC Pathway to Excellence® designated hospitals in Maryland. UM BWMC features one of the state's busiest emergency departments, as well as a team of experts who care for our community and one another. The University of Maryland Baltimore Washington Medical Center (UMBWMC) provides the highest quality health care services to the communities we serve. Our medical center is home to leading-edge technology, nationally recognized quality, personalized service and outstanding people. We have 285 licensed beds and we're home to 3,200 employees and over 800 physicians. Our expert physicians and experienced, compassionate staff are connected to medical practices in the local community as well as at University of Maryland Medical Center in downtown Baltimore. For patients, this means access to high-quality care and research discoveries aimed at improving Maryland's health. Our physicians and nursing staff specialize in emergency, acute, medical-surgical and critical care. In addition, our medical center is home to many Centers of Excellence, offering expert outpatient health care.
Job Description
General Summary
Using the established guidelines for Utilization Review, the Utilization Management Coordinator collaborates with members of the hospital team, the insurance provider, and regulatory agencies to assure compliance with regulatory and reimbursement requirements.The position is goal-oriented with a high level of accountability correlated to maximizing reimbursement and minimizing denials.
Mission
All employees are responsible for extending the mission and values of Baltimore Washington Medical Center by dedicating oneself to providing the highest quality healthcare services to the communities we serve.
Reporting Relationships
Reports to the Director of Care Management.
Qualifications
Education:Graduation from an accredited nursing education program approved by the Board of Nursing or found to be substantially equivalent to the programs in Maryland. Currently licensed as a Registered Nurse in the State of Marylandrequired, BSN preferred.
Experience:Three (3) yearsof relevantclinical experience required.Ongoing education, certification, and self development to remain current with industry standards and business objectives related to hospital utilization and case management.
Additional Information
All your information will be kept confidential according to EEO guidelines.
Compensation:
  • Pay Range: $40.61 - $60.96
  • Other Compensation (if applicable):
  • Review the 2025-2026 UMMS Benefits Guide

Like many employers, UMMS is being targeted by cybercriminals impersonating our recruiters and offering fake job opportunities. We will never ask for banking details, personal identification, or payment via email or text. If you suspect fraud, please contact us at careers@umms.edu.

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