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Remote Utilization Management Jobs in Maryland (NOW HIRING)

CareFirst

Clinical Appeals Nurse (Remote)

Baltimore, MD · Remote

Three (3) years Medical Review, Utilization Management, Nurse Auditor/Revenue Integrity, and/or Appeal and Grievance review at CareFirst BlueCross BlueShield, or similar Managed Care organization or ...

Bcbsa

Director, Trade Client Relations

California, MD · Remote

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

Bcbsa

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

CareFirst

Business Consultant (Remote)

Baltimore, MD · Remote

This role serves as a key liaison between the Appeals and Grievances team and interdisciplinary partners including Claims Operations, Service Operations, Utilization Management, Payment Integrity ...

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

Utilizing experience and skills in both care management and utilization management, the Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory ...

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

Utilizing experience and skills in utilization management, the Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory considerations, to determine ...

CareFirst

Care Manager (Remote)

Baltimore, MD · Remote

While this position is remote, the incumbent will be expected to come into a CareFirst location ... Utilization Review, Disease Management or other direct patient care experience. Preferred ...

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Remote Utilization Management information

How does a Remote Utilization Management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive as a Remote Utilization Management Nurse, and why are they important?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

What are the most commonly searched types of Utilization Management jobs in Maryland? The most popular types of Utilization Management jobs in Maryland are:
What are popular job titles related to Remote Utilization Management jobs in Maryland? For Remote Utilization Management jobs in Maryland, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Maryland look for? The top searched job categories for Remote Utilization Management jobs in Maryland are:
What cities in Maryland are hiring for Remote Utilization Management jobs? Cities in Maryland with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Maryland as of July 2026, with employment types broken down into 80% Full Time, 17% Part Time, 1% Temporary, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.

Supervisor, Utilization Management Support

Devoted Health

Nottingham, MD • On-site, Remote

$58K - $80K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 11 days ago

Devoted Health rating

9.0

Company rating: 9.0 out of 10

Based on 14 frontline employees who took The Breakroom Quiz

37th of 301 rated insurance

Job description

Job Description
A bit about this role:
The Supervisor manages the day-to-day operations of the Utilization Management Coordinators, ensuring timely and accurate processing of prior authorization requests. This role is highly hands-on, focusing on daily execution, immediate problem-solving, staff coaching, and maintaining compliance with all regulatory requirements.
Your Responsibilities and Impact will include:
  • Team Leadership & Development: Lead, coach, and develop staff, mentoring them on their competencies and career goals while monitoring productivity, accuracy, and performance; Provide operational and administrative support to the team.
  • Intake & Prior Authorization Oversight: Directly manage daily operations of the Utilization Management Coordinator Team to ensure timely and accurate processing of authorization requests, including triaging and entering incoming PA requests and reaching out to hospitals and provider offices to obtain important clinical documentation; Ensure requests are appropriately entered, documented, and routed for clinical review and determination.
  • Clinical Coordination Management: Oversee the coordination of clinical reviews and peer-to-peer (P2P) scheduling between providers and Medical Directors, including contacting providers to communicate clinical decisions; Ensure all required documentation is present for clinical review, including managing RFI work and EHR access workflows.
  • Operational Performance & Compliance: Plan, organize, and coordinate the team's work and initiatives to ensure achievement of specific, measurable goals and deadlines, including meeting service level agreements and regulatory turnaround time requirements; Monitor work queues, daily census checks, and operational metrics; Identify obstacles, problem-solve, and implement changes to enhance workflow efficiency and ensure compliance with CMS, Medicare Advantage, and internal UM policies and procedures.
  • AI Workflow Ownership: Act as the domain owner for Utilization Management AI workflows for the team, responsible for the full lifecycle, including building, executing, implementing, and monitoring the performance and refinement of AI/LLM-enabled tools; Define and track quality metrics (accuracy, throughput) for AI-enabled processes, interpreting data and making iteration decisions in partnership with AI Enablement Partners ; Ensure local governance and adherence to AI use policies within the team.
  • Cross-Functional Collaboration: Cultivate and maintain strong partnerships with clinical leadership, provider relations, claims, and other internal teams to support seamless UM operations, including care transition workflows and case follow-up.

Required skills and experience:
  • 3+ years of utilization management or prior authorization experience.
  • 1+ year of prior leadership or supervisory experience required.
  • Experience in Medicare Advantage or managed care.
  • Knowledge of prior authorization workflows, clinical review processes, and regulatory requirements (e.g., Medicare Advantage).
  • Strong organizational, communication, and operational management skills.
  • Excellent problem-solving and analytical skills.
  • Experience in a fast-paced, high-volume environment.
  • Proficiency with healthcare systems, EHRs, and reporting tools.
  • Experience driving technology-enabled workflow improvements, particularly with AI/LLM tools.

Desired skills and experience:
  • Bachelor's degree in healthcare operations, business administration, or a related field preferred.
  • Experience with Intake, authorization, or clinical coordination processes.
  • Familiarity with UM or case management workflows.

#LI-Remote
Salary range: $58,000 - $80,000 annually
The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Our Total Rewards package includes:
  • Employer sponsored health, dental and vision plan with low or no premium
  • Generous paid time off
  • $100 monthly mobile or internet stipend
  • Stock options for all employees
  • Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
  • Parental leave program
  • 401K program
  • And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going - all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted's Code of Conduct, our company values and the way we do business.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

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