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Online Utilization Review Jobs in Silver Spring, MD

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How much do online utilization review jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for online utilization review in Silver Spring, MD is $43.71, according to ZipRecruiter salary data. Most workers in this role earn between $34.52 and $50.19 per hour, depending on experience, location, and employer.

What is an online utilization review?

An Online Utilization Review is a process in which healthcare professionals evaluate the necessity, efficiency, and appropriateness of medical services, procedures, or hospital admissions using digital platforms. This review is typically conducted remotely, using electronic health records and online communication tools to assess patient care. The goal is to ensure that patients receive the most effective care while avoiding unnecessary treatments and controlling healthcare costs. Online Utilization Review professionals may work for hospitals, insurance companies, or third-party administrators to maintain quality standards and compliance with regulations.

What are the key skills and qualifications needed to thrive as an online utilization review specialist?

To thrive as an Online Utilization Review Specialist, you need a solid background in nursing or healthcare, with credentials such as an RN or LPN license and experience in clinical review processes. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines and medical necessity criteria are typically required. Strong analytical thinking, attention to detail, and clear written communication help you effectively assess cases and interact with healthcare providers. These skills ensure accurate case reviews, compliance with regulations, and optimal patient care while controlling healthcare costs.

What are some common challenges faced by professionals in online utilization review, and how can they be addressed?

One common challenge in Online Utilization Review is staying up-to-date with changing regulations and payer requirements, which can impact approval criteria and documentation standards. Another challenge is effectively managing a high volume of cases while maintaining accuracy and meeting turnaround times. Building strong communication skills for collaborating with providers and interdisciplinary teams is also crucial. To address these challenges, professionals often participate in ongoing training, utilize clinical decision support tools, and foster open communication with team members and stakeholders.

What is the difference between Online Utilization Review vs Utilization Review Coordinator?

AspectOnline Utilization ReviewUtilization Review Coordinator
CredentialsTypically requires healthcare or insurance certifications, such as RN, CPC, or CCMOften requires similar certifications, with additional administrative or coordination training
Work EnvironmentRemote or office-based, reviewing patient records and insurance claims onlineOffice setting, coordinating reviews and communicating with providers and patients
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare facilities, third-party review agencies

Online Utilization Review involves assessing medical necessity and coverage remotely using digital records, while Utilization Review Coordinator manages the review process, coordinating between providers and insurers. Both roles require similar credentials and are integral to healthcare and insurance industries, but Online Utilization Review is more focused on remote case assessments, whereas the Coordinator handles administrative oversight.

How do I get into an online utilization review?

To become an online utilization review specialist, you typically need a healthcare-related degree such as nursing, health administration, or a related field, along with knowledge of insurance policies and medical terminology. Certification in utilization review or case management, like the Certified Professional in Healthcare Quality (CPHQ), can improve job prospects. Relevant skills include strong analytical abilities, attention to detail, and familiarity with electronic health records and review software.

What are the most commonly searched types of Utilization Review jobs in Silver Spring, MD?

The most popular types of Utilization Review jobs in Silver Spring, MD are:

What are popular job titles related to Online Utilization Review jobs in Silver Spring, MD?

For Online Utilization Review jobs in Silver Spring, MD, the most frequently searched job titles are:

What job categories do people searching Online Utilization Review jobs in Silver Spring, MD look for?

The top searched job categories for Online Utilization Review jobs in Silver Spring, MD are:

What cities near Silver Spring, MD are hiring for Online Utilization Review jobs?

Cities near Silver Spring, MD with the most Online Utilization Review job openings:

Online Utilization Review jobs near you

Utilization Review Nurse RN - NE

LifeBridge Health, Inc.

Randallstown, MD • On-site

$40.12 - $62.19/hr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 22 days ago

LifeBridge Health rating

6.3

Company rating: 6.3 out of 10

Based on 80 frontline employees who took The Breakroom Quiz

670th of 898 rated healthcare providers

Job description

Work Schedule: This is an EVERY Saturday and Sunday role

Summary:

The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart review for clinical, financial and resource utilization information. Provides intervention and coordination to decrease avoidable delays and denial of payment. Interfaces with 3rd party payers by providing pertinent, relevant clinical information.

Responsibilities Include:

Reviews the medical record by applying utilization review criteria, to assess clinical, financial, and resource consumption. Enters clinical reviews into the software program. Maintains close communication with external reviewers/internal financial counselors/patient access personnel and performs certification activities as required by payor.

Monitors and identifies patterns or trends in utilization management. Monitors potential and actual denials and coordinates with nurse Care Manager and/or Social Worker for any follow up necessary. Documents in software program the actions taken to coordinate care and avoid denials. Assists nurse Care Managers in communicating with the patient denied hospital days as well as the issuance of Medicare forms including HINN, Detailed Notice of Discharge to patients/family/significant other when they are in disagreement with the discharge plan arranged by attending and Care Management personnel.

Coordinates with the Care Manager to achieve optimal and efficient patient outcomes, while decreasing length of stay and avoid delays and denied days. Utilizes Physician Advisor and administrative personnel for unresolved issues. Identifies opportunities for expedited appeals and collaborates with the Care Manager and Physician Advisor to resolve payer issues. Other tasks as assigned.

Sends appropriate referrals/escalations to the physician advisors to review cases not met with criteria

REQUIREMENTS:

Registered Nurse License - Current Maryland license or eligibility to obtain Maryland license

Associate's Degree in Nursing required; BSN or higher preferred

Minimum of 3 years of related experience


Pay Range: $40.12 to $62.19 Based On Experience

Benefits:

Medical, dental, and vision coverage starting the first of the month after hire, plus wellness programs and mental health support

403(b) retirement plan with employer match, pension, and life and disability insurance

Tuition reimbursement toward advanced degrees and specialty certifications

Generous paid time off, fitness discounts, and free on-site parking

About Northwest Hospital

Northwest Hospital is a full-service community hospital in Baltimore County serving Randallstown, Pikesville, Owings Mills, and beyond. As part of LifeBridge Health - one of the region's most comprehensive healthcare systems - Northwest delivers compassionate, high-quality care close to home, with a mission to improve the health of the communities we serve, and to take care of the people who take care of patients.

About LifeBridge Health

LifeBridge Health is a dynamic, purpose-driven health system redefining care delivery across the mid-Atlantic and beyond, anchored by our mission to "improve the health of people in the communities we serve." Join us to advance health access, elevate patient experiences, and contribute to a system that values bold ideas and community-centered care.

With over 14,000 employees, 130 care locations, and two million annual patient encounters, we combine strategic growth, innovation, and deep community commitment to deliver exceptional care anchored by five leading centers in Maryland.

Our organization thrives on a culture of CARE BRAVELY-where compassion, courage, and urgency drive every decision, empowering teams to shape the future of healthcare.

LifeBridge Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex or sexual orientation and gender identity/expression. LifeBridge Health does not exclude people or treat them differently because of race, color, national origin, age, disability, sex or sexual orientation and gender identity/expression.

What LifeBridge Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About LifeBridge Health

Sourced by ZipRecruiter

LifeBridge Health is a $2B, 13,000 team member healthcare system that Cares Bravely for over 1 million patients annually throughout Maryland. We are comprised of 5 main healthcare centers: Sinai Hospital, Northwest Hospital, Carroll Hospital, Levindale Hebrew Geriatric Center and Hospital, and Grace Medical Center as well as several specialty and primary care locations throughout Baltimore.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Baltimore, MD, US

Year founded

1988

Social media

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