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Manager Utilization Management Jobs in Baltimore, MD

MedStar Health

Director Case Management

Columbia, MD · On-site

The Director of Case Management (DCM) oversees case management activities that may include behavioral health utilization management and care management functions and serves as a liaison to government ...

Global Alliant Inc

Clinical Analyst

Baltimore, MD · Remote

Utilization Management / Utilization Review / Prior Authorization * Clinical or healthcare educational background * ICD-10, CPT, HCPCS * Claims, denials, billing or medical-necessity review

Global Alliant Inc

Clinical Analyst

Baltimore, MD · On-site

Utilization Management / Utilization Review / Prior Authorization * Clinical or healthcare educational background * ICD-10, CPT, HCPCS * Claims, denials, billing or medical-necessity review

Global Alliant Inc

Clinical Analyst

Baltimore, MD · Remote

Utilization Management / Utilization Review / Prior Authorization * Clinical or healthcare educational background * ICD-10, CPT, HCPCS * Claims, denials, billing or medical-necessity review

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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Baltimore, MD

Manager Utilization Management information

See Baltimore, MD salary details

$38.8K

$90.4K

$166.4K

How much do manager utilization management jobs pay per year?

As of Sep 5, 2026, the average yearly pay for manager utilization management in Baltimore, MD is $90,432.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,100.00 and $108,800.00 per year, depending on experience, location, and employer.

What does a manager utilization management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.

What are the key skills and qualifications needed to thrive as a manager utilization management?

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What are some common challenges faced by a manager utilization management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What is the difference between Manager Utilization Management vs Utilization Review Nurse?

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are the most commonly searched types of Utilization Management jobs in Baltimore, MD?

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

What are popular job titles related to Manager Utilization Management jobs in Baltimore, MD?

For Manager Utilization Management jobs in Baltimore, MD, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in Baltimore, MD look for?

The top searched job categories for Manager Utilization Management jobs in Baltimore, MD are:

What cities near Baltimore, MD are hiring for Manager Utilization Management jobs?

Cities near Baltimore, MD with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Baltimore, MD as of August 2026, with employment types broken down into 85% Full Time, and 15% Contract. Highlights an 100% In-person job distribution, with an average salary of $90,432 per year, or $43.5 per hour.

Utilization Review Nurse (Full-Time)

Greater Baltimore Medical Center Healthcare

Towson, MD • On-site

Full-time

Posted 23 days ago

Key responsibilities

  • Reviews electronic medical records during the pre-admission process to determine appropriate patient status.

  • Develops initial admission reviews and provides timely status recommendations to admitting providers.

  • Assists with discharge planning and coordinates services with managed care companies and third-party payers.

Job description

Under general supervision, provides consultative support to the admitting teams concerning patient status determinations and utilization of hospital resources facilitating quality, cost-effective patient outcomes for patients requiring hospital services. Works collaboratively with interdisciplinary staff internal and external to the organization facilitating appropriate status determinations through the utilization review process supporting quality, cost-effective patient outcomes. Responsible for analyzing clinical information and performing timely initial and concurrent reviews using InterQual screening software to identify appropriate medical necessity, length of stay, and level of care based upon evidence based clinical guidelines
Education:
Bachelor of Science in Nursing (BSN) OR Associate of Science in Nursing and currently enrolled in a BSN program with an expected graduation date within three (3) years.
Licensure, Certifications:
  • Current state of Maryland Registered Nurse license
  • Bachelor of Science in Nursing (BSN)
  • Certification in Utilization Management and/or Care Management highly desired.

Experience:
Five (5) years diversified, progressive experience in acute care and/or other settings within the continuum required.
Two (2) years of Utilization Review and Case Management experience which includes utilization review processes and discharge planning, and working with Re-Admission Initiatives preferred.
Skills:
• Advanced knowledge of InterQual and/or MCG admission criteria
• Knowledge of healthcare regulatory standards
• Advanced skill in using computer software
• Advanced skill in oral and written communication
• Advanced skill in critical thinking
• Ability to work independently and resolve complex problems
• Ability to remain calm under pressure and intense time constraints
• Ability to assess discharge needs for patients
• Strong analytical and problem-solving skills
• Strong interpersonal communication and influencing skills necessary to interact effectively with physicians, payers, regulatory agencies, staff, and other health professional
• Strong organizational and time management skills
• Ability to operate independently and balance multiple priorities
• Proficiency in electronic medical record review
Principal Duties and Responsibilities:
  • Reviews available electronic medical records during the pre-admission process to determine appropriate patient status, optimizing correct patient classification and corresponding payer notifications.
  • Reviews the appropriateness of admission and continued stay criteria for a defined group of patients
  • Develops initial admission reviews for patients requiring hospital services and provides timely status recommendations to admitting providers a concurrent stay and/or discharge plan of care in accordance with departmental and payer clinical guidelines.
  • Maintains a working knowledge of contractual and clinical criteria guidelines. Coordinates services with managed care companies and other third party payers. Discusses on-site reviewer issues with payer, either via the telephone or in person
  • Assures timely utilization compliance with all payers who require authorizations and clinical submission. Demonstrates knowledge of reimbursement mechanisms. Considers patient's financial resources for meeting healthcare needs (insurance reimbursement, managed care plans, entitlement programs, and personal resources).
  • Participates as an active partner with physicians and interdisciplinary teams, providing education ancillary, and nursing staffregarding admission decisions including status determinations, financial and clinical outcomes, and documentation requirements and standards.
  • Maintains current knowledge on all regulatory changes that affect care delivery or reimbursement of acute care services. Uses
  • knowledge of national and local coverage determinations to appropriately advise physicians.
  • Identifies system obstacles that affect patient outcomes and participates in interdisciplinary decisions and care of the patient. consults with interdisciplinary team members to address problems, and makes recommendations to problem solve.
  • Assists with discharge planning, by preventing un-necessary hospital utilization, assist in the appropriate return of and placement of patients to post acute care, community based care and appropriate alternate levels of care.
  • Demonstrates mastery in InterQual level of care guidelines. Possesses proficiency in utilization review systems, clinical support systems, and business support applications.
  • Promotes use of evidence-based protocols to influence high quality and cost-effective care.
  • Escalates clinically and financially complex cases to leadership, offering possible solutions through discussion and feedback. Engages regularly in formal and informal dialogue about quality; directly addressing concerns and promoting continuous improvement.
  • Performs concurrent reviews and additional duties as assigned.

All roles must demonstrate GBMC Values:
Respect
I will treat everyone with courtesy. I will foster a healing environment.
  • Treats others with fairness, kindness, and respect for personal dignity and privacy
  • Listens and responds appropriately to others' needs, feelings, and capabilities

Excellence
I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.
  • Meets and/or exceeds customer expectations
  • Actively pursues learning and self-development
  • Pays attention to detail; follows through

Accountability
I will be professional in the way I act, look and speak. I will take ownership to solve problems.
  • Sets a positive, professional example for others
  • Takes ownership of problems and does what is needed to solve them
  • Appropriately plans and utilizes required resources for various job duties
  • Reports to work regularly and on time

Teamwork
I will be engaged and collaborative. I will keep people informed.
  • Works cooperatively and collaboratively with others for the success of the team
  • Addresses and resolves conflict in a positive way
  • Seeks out the ideas of others to reach the best solutions
  • Acknowledges and celebrates the contribution of others

Ethical Behavior
I will always act with honesty and integrity. I will protect the patient.
  • Demonstrates honesty, integrity and good judgment
  • Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers

Results
I will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals.
  • Embraces change and improvement in the work environment
  • Continuously seeks to improve the quality of products/services
  • Displays flexibility in dealing with new situations or obstacles
  • Achieves results on time by focusing on priorities and manages time efficiently

Pay Range
$68,281.18 - $110,274.20
Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.
Equal Employment Opportunity
GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

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