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Part Time Utilization Review Jobs in Maryland (NOW HIRING)

Pyramid Healthcare

Part Time Evening Counselor

Joppa, MD · On-site

$48K - $65K/yr

... Part Time, Evenings (some Flexibility) Are you passionate about helping individuals overcome ... utilization review processes and continued-stay authorizations. * Support discharge planning ...

Pacs

$60 - $65/hr

Physical Therapist (PT) - Full-Time & Part-Time Location: Sequoia Transitional Care - Porterville ... Participate in interdisciplinary meetings including Care Conferences and Utilization Reviews

Pacs

Participates in Resident Care conferences, Utilization Review meetings, and Rehabilitation meetings as needed. * Provides in-services on training programs for other staff in the facility as needed.

Encompass Health Corporation

Case Manager II

Bowie, MD · On-site

Affordable medical, dental, and vision plans for both full-time and part-time employees and their ... Participate in utilization review process: data collection, trend review, and resolution actions.

Encompass Health

Case Manager

Bowie, MD

$19.25 - $24.75/hr

Affordable medical, dental, and vision plans for both full-time and part-time employees and their ... Participate in utilization review process: data collection, trend review, and resolution actions.

Encompass Health

Case Manager II

Bowie, MD

Affordable medical, dental, and vision plans for both full-time and part-time employees and their ... Participate in utilization review process: data collection, trend review, and resolution actions.

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

Part Time Utilization Review information

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$20

$41

$66

How much do part time utilization review jobs pay per hour?

As of Sep 8, 2026, the average hourly pay for part time utilization review in Maryland is $41.04, according to ZipRecruiter salary data. Most workers in this role earn between $32.45 and $47.12 per hour, depending on experience, location, and employer.

What is a part time utilization review?

A Part Time Utilization Review job involves evaluating healthcare services provided to patients in order to ensure they are medically necessary and cost-effective. Professionals in this role review patient records, treatment plans, and insurance information to make recommendations about the appropriateness of care. Working part-time, they may collaborate with healthcare providers, insurance companies, and patients to optimize healthcare outcomes while managing costs. This position is often found in hospitals, insurance companies, or healthcare management organizations, and typically requires a background in nursing or healthcare administration.

What are the key skills and qualifications needed to thrive as a part time utilization review nurse?

To thrive as a Part Time Utilization Review Nurse, you need a current RN license, strong clinical assessment skills, and experience in case management or utilization review. Familiarity with healthcare management systems, InterQual or MCG guidelines, and insurance authorization processes is typically required. Excellent analytical thinking, attention to detail, and effective communication help in collaborating with healthcare providers and payers. These skills ensure appropriate resource use, regulatory compliance, and optimal patient outcomes in a part-time capacity.

What are some common challenges faced in a part time utilization review role and how can I effectively manage them?

Part-time utilization review professionals often face challenges such as managing fluctuating caseloads within limited hours and staying up-to-date with rapidly changing healthcare regulations. Balancing efficiency and thoroughness is crucial, especially when reviewing complex cases or communicating with providers on tight timelines. Effective time management, strong organizational skills, and clear communication with your team are key to overcoming these challenges. Many employers provide flexible schedules and supportive technology platforms, which can help streamline your workflow and maintain high-quality reviews.

What is the difference between Part Time Utilization Review vs Part Time Case Management?

AspectPart Time Utilization ReviewPart Time Case Management
CredentialsTypically requires healthcare-related certifications (e.g., RN, LPN, or medical reviewer credentials)Often requires social work, nursing, or healthcare certifications, with some overlap
Work EnvironmentHealthcare facilities, insurance companies, or third-party review organizationsHospitals, insurance companies, or community health agencies
Employer & Industry UsageUsed mainly in insurance and healthcare to evaluate medical necessityUsed in healthcare to coordinate patient care and services

Part Time Utilization Review focuses on assessing the medical necessity of services, while Part Time Case Management involves coordinating patient care and services. Both roles require healthcare credentials and are common in insurance and healthcare settings, but they serve different functions within patient care and resource management.

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

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

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

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

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

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

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

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

Part Time Utilization Review jobs near you
Infographic showing various Part Time Utilization Review job openings in Maryland as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 11% Part Time, 1% Temporary, and 2% Contract. Highlights an 88% Physical, 3% Hybrid, and 9% Remote job distribution, with an average salary of $85,356 per year, or $41 per hour.

Clinical Pharmacist Reviewer - Part-time

J29 Inc.

Millersville, MD • On-site, Remote

$115K - $137K/yr

Part-time

Posted 4 days ago

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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