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Part Time Remote Utilization Review Jobs in Maryland

Brighter Day Services

Finance Coordinator

Towson, MD · Remote

$22/hr

THE ROLE The Finance & Admin Coordinator is a part-time remote contractor role reporting directly ... Conduct a monthly review of all active platform subscriptions and costs. * Identify any unused ...

Brighter Day Services LLC

Finance Coordinator

Towson, MD · On-site +1

$22/hr

THE ROLE The Finance & Admin Coordinator is a part-time remote contractor role reporting directly ... Conduct a monthly review of all active platform subscriptions and costs. * Identify any unused ...

Harris

Part-time team members will typically need to dedicate an average of 20-30 hours per week to care ... Chart Review: 8 min Outreach Attempts: 6 min Actual Call: 11 min Care Coordination: 9 min Total ...

Harris

Part-time team members will typically need to dedicate an average of 20-30 hours per week to care ... Chart Review: 8 min Outreach Attempts: 6 min Actual Call: 11 min Care Coordination: 9 min Total ...

Harris

Remote Care Management - CMA

California, MD · Remote

Part-time team members will typically need to dedicate an average of 20-30 hours per week to care ... Chart Review: 8 min Outreach Attempts: 6 min Actual Call: 11 min Care Coordination: 9 min Total ...

Beacon Talent

Remote Psychiatrist

Leonardtown, MD · Remote

$150 - $200/hr

Location: Remote (United States) Type: 1099 Independent Contractor, Part-Time or Full-Time ... Document within our behavioral health EMR to the standard required for payer review * Escalate ...

Beacon Talent

Remote Psychiatrist

Lexington Park, MD · Remote

$150 - $200/hr

Location: Remote (United States) Type: 1099 Independent Contractor, Part-Time or Full-Time ... Document within our behavioral health EMR to the standard required for payer review * Escalate ...

Beacon Talent

Remote Psychiatrist

Cheltenham, MD · Remote

$150 - $200/hr

Location: Remote (United States) Type: 1099 Independent Contractor, Part-Time or Full-Time ... Document within our behavioral health EMR to the standard required for payer review * Escalate ...

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All JobsUtilization Review JobsPart Time Remote Utilization Review JobsPart Time Remote Utilization Review Jobs in Maryland

Part Time Remote Utilization Review information

What is a part time remote utilization review?

A Part Time Remote Utilization Review position involves evaluating medical records and healthcare services to ensure they are necessary and appropriate, typically for insurance companies or healthcare providers. This job is performed remotely, allowing professionals to work from home or another location outside of a traditional office setting. Part-time roles generally require fewer hours than full-time positions, making them suitable for those seeking flexible schedules. Professionals in this role often have backgrounds in nursing or healthcare and use their expertise to review patient care for quality and cost-effectiveness.

What skills and qualifications are needed for a part time remote utilization review?

To thrive as a Part Time Remote Utilization Review Nurse, you need a current RN license, strong clinical judgment, and in-depth knowledge of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, electronic health records (EHRs), and systems such as InterQual or MCG is typically required. Excellent communication, critical thinking, and self-motivation are vital soft skills for coordinating care and making independent decisions remotely. These skills ensure accurate case evaluations, regulatory compliance, and effective collaboration with healthcare teams while working from a remote setting.

What challenges do part time remote utilization review professionals face, and how can they be managed?

Part-time remote utilization review professionals often face challenges such as balancing a variable workload, ensuring timely communication with healthcare providers, and staying current with changing insurance guidelines. Since much of the work is done independently, strong time management and self-motivation are essential to meet review deadlines. Regularly scheduled check-ins with the team and utilizing digital collaboration tools can help maintain connectivity and support. Staying organized and proactive in seeking clarification when needed can mitigate common challenges and lead to a successful experience in this role.

What is the difference between Part Time Remote Utilization Review vs Part Time Remote Claims Reviewer?

AspectPart Time Remote Utilization ReviewPart Time Remote Claims Reviewer
CredentialsTypically requires healthcare licenses (e.g., RN, MD) and utilization review certificationsUsually requires insurance or claims processing experience, with some industry-specific certifications
Work EnvironmentRemote, healthcare-focused, reviewing medical necessity and appropriateness of careRemote, insurance or healthcare claims processing, verifying coverage and claims accuracy
Employer & Industry UsageHospitals, insurance companies, healthcare organizationsInsurance companies, third-party administrators, healthcare payers

Part Time Remote Utilization Review and Part Time Remote Claims Reviewer both operate remotely but focus on different aspects of healthcare administration. Utilization reviewers assess medical necessity, while claims reviewers verify insurance claims. Understanding these differences helps job seekers find roles aligned with their skills and credentials.

What are the most commonly searched types of Remote Utilization Review jobs in Maryland?

The most popular types of Remote Utilization Review jobs in Maryland are:

What are popular job titles related to Part Time Remote Utilization Review jobs in Maryland?

For Part Time Remote Utilization Review jobs in Maryland, the most frequently searched job titles are:

What job categories do people searching Part Time Remote Utilization Review jobs in Maryland look for?

The top searched job categories for Part Time Remote Utilization Review jobs in Maryland are:

What cities in Maryland are hiring for Part Time Remote Utilization Review jobs?

Cities in Maryland with the most Part Time Remote Utilization Review job openings:

Part Time Remote Utilization Review jobs near you
Infographic showing various Part Time Remote Utilization Review job openings in Maryland as of August 2026, with employment types broken down into 100% Part Time. Highlights an 100% Remote job distribution.

Clinical Pharmacist Reviewer - Part-time

J29 Inc.

Millersville, MD • On-site, Remote

$115K - $137K/yr

Part-time

Posted 3 days ago

New

Job description

This position is contingent upon the successful award of the associated contract. Employment is not guaranteed until the contract is awarded, and the position is officially activated. Job responsibilities and requirements are subject to change.
Position: Clinical Pharmacist Reviewer
Location: Remote
Status: Part-time
About J29
J29 is an employee centered healthcare management consulting company that specializes in processing, reviewing, and analyzing medical claims, records, disputes, and audits. Established in 2017, J29 prides itself on its employee centric culture and high employee retention rates that allow us to ensure that we are creating a working environment that prioritizesthe employeeexperience. Our team brings corporate performance that stretches to various areas where we can provide our clinical, healthcare policy, and complianceexpertisethrough our support to health and human service programs at the State, Federal, and Commercial levels.
Overview
J29 is seeking an experienced Clinical Pharmacist Reviewer to support the contract through the independent clinical review of Medicare Part D reconsideration appeals and program integrity-related activities. The Clinical Pharmacist Reviewer applies advanced clinical knowledge, Medicare Part D regulations, CMS guidance, and pharmacy benefit expertise to evaluate appeal cases, assess coverage eligibility, and support accurate and defensible determination recommendations.
Working within a multidisciplinary review environment, the Clinical Pharmacist Reviewer analyzes clinical and pharmacy documentation, evaluates complex drug coverage issues, and ensures compliance with applicable regulatory and contractual requirements. The ideal candidate possesses deep knowledge of Medicare Part D operations, strong analytical skills, and the ability to independently assess cases while maintaining the highest standards of quality, consistency, and program integrity.
Role & Responsibilities
  • Perform independent clinical and policy review of reconsideration appeals
  • Perform independent clinical and policy reviews of Medicare Part D reconsideration appeals.
  • Apply Medicare Part D statutes, regulations, CMS guidance, and contract-specific requirements in the evaluation of appeal cases.
  • Assess clinical documentation, pharmacy claims, and supporting records to determine coverage eligibility and payment appropriateness.
  • Evaluate medical necessity, formulary requirements, utilization management criteria, and benefit coverage limitations.
  • Analyze Prescription Drug Event (PDE) data and other relevant documentation as part of the appeal review process.
  • Draft clear, concise, and well-supported clinical recommendations and determination rationales.
  • Identify discrepancies, documentation deficiencies, or potential compliance concerns during case reviews.
  • Collaborate with medical reviewers, appeals analysts, and operational staff to resolve complex cases and ensure consistent adjudication.
  • Maintain complete and accurate documentation of review findings in accordance with program requirements.
  • Participate in quality assurance reviews, calibration activities, and peer review processes.
  • Support audit readiness efforts and respond to quality or compliance inquiries as needed.
  • Assist in the development and refinement of clinical review guidelines, training materials, and operational procedures.
  • Ensure compliance with CMS regulations, Medicare Part D requirements, HIPAA standards, and organizational policies.
  • Support activities that promote program integrity and the accurate administration of Medicare benefits.

Experience / Expertise
  • Doctor of Pharmacy (PharmD) or Bachelor of Science in Pharmacy required.
  • Active, unrestricted pharmacist license in good standing.
  • Five (5) or more years of experience supporting Medicare Part D operations, appeals, utilization management, pharmacy benefit management, healthcare compliance, audit activities, or program integrity initiatives.
  • Strong knowledge of Medicare Part D regulations, coverage determinations, formulary administration, appeals processes, and Prescription Drug Event (PDE) requirements.

Preferred Qualifications
  • Experience reviewing pharmacy claims, clinical documentation, and complex coverage determinations.
  • Ability to interpret CMS guidance, federal regulations, and pharmacy policies to support consistent and compliant decision-making.
  • Strong clinical assessment, analytical, and critical thinking skills.
  • Experience preparing written clinical findings, recommendations, and appeal determination rationales.
  • Knowledge of drug utilization review, medication safety principles, and evidence-based clinical practice.
  • Experience supporting CMS contractors or other healthcare oversight organizations preferred.
  • Strong written and verbal communication skills.
  • Proficiency in Microsoft Office applications and electronic case management systems.
  • Ability to manage multiple priorities while maintaining exceptional attention to detail and quality.

Hourly Rate: $65.00 - 68.00 hourly
J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. J29, Inc. is a proud Veteran friendly employer.
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About J29

Sourced by ZipRecruiter

Industry

Business management consulting

Company size

1 - 10 Employees

Headquarters location

Millersville, MD, US

Year founded

2017

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