ZipRecruiter

Log In

2

Remote Utilization Management Jobs in Baltimore, MD

System One

Lead Healthcare Product Owner

Baltimore, MD · Remote

$72/hr

... Remote (must work Eastern Time core hours ) Type: Contract (~ 7 months , Possible extension ... utilization management / PA programs . * 8-10+ years operating as a Product Owner (or equivalent ...

System One

Lead Healthcare Product Owner

Baltimore, MD · Remote

$72/hr

... Remote (must work Eastern Time core hours ) Type: Contract (~ 7 months , Possible extension ... utilization management / PA programs . * 8-10+ years operating as a Product Owner (or equivalent ...

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 ...

previous page

Showing results 41-60

All JobsUtilization Management JobsRemote Utilization Management JobsRemote Utilization Management Jobs in Baltimore, MD

Remote Utilization Management information

See Baltimore, MD salary details

$21

$42

$68

How much do remote utilization management jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for remote utilization management in Baltimore, MD is $42.01, according to ZipRecruiter salary data. Most workers in this role earn between $33.22 and $48.27 per hour, depending on experience, location, and employer.

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 are the key skills and qualifications needed to thrive in remote utilization management?

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.

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 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 Baltimore, MD?

The most popular types of Utilization Management jobs in Baltimore, MD are:

What are popular job titles related to Remote Utilization Management jobs in Baltimore, MD?

For Remote Utilization Management jobs in Baltimore, MD, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Management jobs in Baltimore, MD look for?

The top searched job categories for Remote Utilization Management jobs in Baltimore, MD are:

What cities near Baltimore, MD are hiring for Remote Utilization Management jobs?

Cities near Baltimore, MD with the most Remote Utilization Management job openings:

Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Baltimore, MD as of August 2026, with employment types broken down into 1% As Needed, 83% Full Time, 13% Part Time, and 3% Contract. Highlights an 86% Physical, 3% Hybrid, and 11% Remote job distribution, with an average salary of $87,387 per year, or $42 per hour.

Lead Healthcare Product Owner

System One

Baltimore, MD • Remote

$72/hr

Contractor

Medical, Dental, Vision, Life, Retirement

Re-posted 14 hours ago

Job description

Lead Product Owner / Business Integration Lead (Prior Authorization) Location/Work model: 100% Remote (must work Eastern Time core hours) Type: Contract (~7 months, Possible extension) Compensation: $72/HR
About the role We’re looking for a Lead Product Owner / Business Integration Lead to stabilize and improve end-to-end Prior Authorization (PA) operations and the supporting technology/process integrations. This is a true hybrid role (Product Owner + Business Integration Lead) focused on fixing real breakdowns in the PA-to-claims flow—identifying failure points, driving corrective action, and delivering improvements that impact accuracy, turnaround time, and provider experience. This role is ideal for someone who has deep payer-side PA domain expertise and can confidently partner across clinical, IT, claims, and operations to drive solutions through to completion. Must-have systems/standards:
  • FACETS (including claims-to-operations “matching”)
  • GuidingCare (especially downstream workflow after the authorization leaves GuidingCare)
  • EDI 278
What you’ll do (Day-to-day)
  • Own end-to-end Prior Authorization (PA) program delivery across clinical, technical, and operational teams.
  • Lead requirements work: gather, document, validate, and manage functional/non-functional requirements, translating them into user stories and acceptance criteria.
  • Drive cross-functional execution across multiple workstreams: stakeholder workshops, design reviews, issue triage, and delivery planning.
  • Identify and resolve breakdowns/errors in the PA/claims process—pinpoint fail points and implement fixes/workarounds with clinical + IT teams.
  • Lead UAT planning and execution: test plans, defect documentation, coordination of fixes, and release readiness.
  • Track and improve PA performance metrics (e.g., turnaround time, denials, provider friction, auto-decision rates).
  • Support change communications/training and provide guidance to other analysts.
Must-Haves (Required) Domain / Experience
  • Deep end-to-end Prior Authorization expertise (not just general “healthcare IT”).
  • 15+ years in payer operations / healthcare delivery / utilization management / PA programs.
  • 8–10+ years operating as a Product Owner (or equivalent end-to-end product delivery lead) in a payer/healthcare environment.
  • Proven ability to lead large, cross-functional, multi-workstream initiatives and drive outcomes to closure.
  • Strong skills in requirements, stakeholder management, process/systems analysis, issue management, and executive-ready communication.
Systems / Workflow Knowledge (must be able to speak to the flow end-to-end)
  • FACETS: working knowledge of claims-to-operations “matching” and how PA/claims flow connects downstream (this is emphasized as critical).
  • GuidingCare: working knowledge, especially what happens after the authorization leaves GuidingCare.
  • EDI 278 experience/knowledge.
Nice-to-Haves (Preferred)
  • MBA (Bachelor’s required or equivalent additional relevant experience).
  • Prior experience helping drive a “task force” / stabilization effort where there are ongoing errors and high-visibility corrective actions.
Education
  • Bachelor’s degree in Business Administration/Management/Finance (or related) or equivalent experience
  • MBA preferred
Quick “Must-Have Keywords” (for screening/search) Prior Authorization (PA) | Utilization Management | Product Owner | Business Integration | FACETS | Claims matching | GuidingCare | EDI 278 | UAT | Requirements | User stories | Acceptance criteria

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

#M-1 #LI-AJ1 Ref: #851-Rockville-S1

System One logo

About System One

Sourced by ZipRecruiter

System One helps employers get work done more efficiently and economically without compromising quality. Over our 35+ year history, we've helped connect thousands of talented people with innovative companies. The excitement of a perfect fit motivates us every single day.

Industry

Business consulting services and recruiting and staffing services

Company size

5,001 - 10,000 Employees

Headquarters location

Pittsburgh, PA, US

View All System One Jobs