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Medstar Health Utilization Review Jobs (NOW HIRING)

Prime Time Healthcare

Utilization Review

Baltimore, MD · On-site

Now Hiring: RN Utilization Review - Baltimore, MD Are you a passionate RN professional looking for ... Prime Time Healthcare is seeking dynamic individuals like you to join our team in Baltimore, MD and ...

Merrimack Health

Utilization Review Nurse

Lawrence, MA · On-site

Utilization Review Nurse Responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for continued stay. Responsible for working with the ...

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Medstar Health Utilization Review information

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How much do medstar health utilization review jobs pay per hour?

As of Sep 9, 2026, the average hourly pay for medstar health utilization review in the United States is $42.28, according to ZipRecruiter salary data. Most workers in this role earn between $33.41 and $48.56 per hour, depending on experience, location, and employer.

What is a MedStar Health utilization review?

A Medstar Health Utilization Review is a process used by Medstar Health to evaluate the necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities. Utilization review professionals assess patient records, treatment plans, and insurance requirements to ensure that patients receive the right care at the right time, while also helping to manage healthcare costs. This process helps maintain quality standards, prevent unnecessary treatments, and ensure compliance with regulations and payer policies.

What are some common challenges faced by utilization review professionals at MedStar Health, and how can these be managed?

Utilization Review professionals at Medstar Health often encounter challenges such as keeping up with frequently changing healthcare regulations, managing high caseloads, and ensuring effective communication with both clinical teams and insurance providers. Successfully managing these challenges typically involves staying current with industry guidelines through ongoing education, utilizing support from multidisciplinary teams, and leveraging Medstar Health’s robust electronic health record systems. Building strong collaboration skills and being proactive in documenting reviews can also help streamline workflows and improve efficiency.

What are the key skills and qualifications needed to thrive as a utilization review specialist at MedStar Health, and why are they important?

To thrive as a Utilization Review Specialist at MedStar Health, you need a clinical background (such as RN or LPN licensure), strong knowledge of medical necessity criteria, and experience in case management or utilization review. Familiarity with electronic medical records (EMR) systems, InterQual or MCG guidelines, and regulatory compliance tools is typically required. Attention to detail, critical thinking, and effective communication are essential soft skills for collaborating with healthcare teams and ensuring accurate assessments. These skills and qualifications ensure appropriate resource use, regulatory compliance, and optimal patient outcomes within the healthcare system.

What is the difference between Medstar Health Utilization Review vs Medstar Health Case Manager?

AspectMedstar Health Utilization ReviewMedstar Health Case Manager
Primary RoleAssessing medical necessity and appropriateness of servicesCoordinating patient care and discharge planning
CredentialsRN, licensed healthcare professionalRN, social worker, or licensed healthcare professional
Work EnvironmentInsurance companies, hospitals, or health plansHospitals, clinics, or community health settings
FocusUtilization review and approvalPatient advocacy and care coordination

While both roles involve healthcare professionals, Medstar Health Utilization Review focuses on evaluating the necessity of services, whereas Medstar Health Case Managers coordinate ongoing patient care and discharge planning. Both roles require similar credentials and often work within the same healthcare environment, but their primary responsibilities differ.

What are popular job titles related to Medstar Health Utilization Review jobs?

For Medstar Health Utilization Review jobs, the most frequently searched job titles are:

Infographic showing various Medstar Health Utilization Review job openings in the United States as of September 2026, with employment types broken down into 2% As Needed, 77% Full Time, 16% Part Time, and 5% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $87,946 per year, or $42.3 per hour.

Hospice/Palliative Medicine Physician

Leonardtown, MD • On-site

MedStar Health
Health Care and Social Assistance • 10K+ employees
Learn more about MedStar Healthexternal

$225K - $300K/yr

Full-time

Medical, PTO

This job post has expired 2 days ago. Applications are no longer accepted.

Medstar Health rating

7.8

Company rating: 7.8 out of 10

Based on 241 frontline employees who took The Breakroom Quiz

137th of 898 rated healthcare providers

Job description

About the Job
Palliative Care Medical Director, MedStar St. Mary's Hospital - Leonardtown, MD
MedStar Health offers a uniquely rewarding career in a major marketplace. Shape your future in health care in the kind of setting that's right for you and your practice. Become part of an organization that welcomes your experience, input and leadership - as a clinician and healthcare expert.
The MedStar Health Palliative Care program has an integrated, patient-centric, and interdisciplinary model of care distributed throughout the Baltimore-Washington region. With over 50 team members, MedStar Health has one of the largest palliative care programs in the country.
By joining MedStar Health you will receive many great benefits to include:
  • Guaranteed base compensation
  • Signing and other bonuses
  • CME paid time off and stipend
  • Much more!
The goal at MedStar Health is to provide patients with easy access to highly qualified physicians focused on an excellent patient experience, while delivering world-class quality care.
Position highlights:
  • Be a part of the largest and strongest academic community hospitals in the region
  • Ability to care for medically complex patients
  • Join a very strong, supportive, experienced team
The candidate will be the on-site Medical Director and enjoy providing clinical care at MedStar St. Mary's Hospital. The position will be 90% clinical and 10% Medical Director.
As a MedStar Palliative Care physician leader, you will:
  • Build effective relationships with referring physicians, identify opportunities to improve patient care, and improve efficiency and effectiveness of the service.
  • Ensure compliance with legal, regulatory, and clinical policies and procedures.
  • Demonstrate best practices and actively engage in teaching other team members and learners in the process.
  • Collaborate with others as appropriate to ensure that palliative clinical protocols, utilization review, case management, quality assurance, and compliance programs are implemented according to hospital policies.
Be a part of a nationally-recognized health system and the largest provider of health services in the Baltimore/Washington region. With our vast resources and capabilities at your disposal, you can expand your clinical expertise. Enjoy a rich career and a quality of life unique to Baltimore and the Mid-Atlantic region, which features a mix of urban, suburban and rural communities.
This position has a salary range of $225,000 - $300,000.
This position has a hiring range of
USD $225,000.00 - USD $300,000.00 /Yr.

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About Medstar Health

Sourced by ZipRecruiter

MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Columbia, MD, US

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