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Remote Utilization Review Manager Jobs in Maryland

RELI Group Inc.

Medical Review Nurse III

Baltimore, MD · On-site +1

$80K - $95K/yr

... Determinations, utilization/practice guidelines, and clinical review judgment. Provides ... Report problems to the Medical Review Manager (MRM) and Project Manager (PM) regarding unique ...

Global Alliant Inc

Clinical Analyst

Baltimore, MD · Remote

Remote JobDuration: Contract / FTE Client: Federal Criteria-Need US citizenshipbecause of federal ... Utilization Management / Utilization Review / Prior Authorization * Clinical or healthcare ...

Maryland Physicians Care

Pharmacy Benefit Coordinator

Linthicum, MD · On-site +1

$67K - $72K/yr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... management (PBM) vendor and the organization's utilization review, quality improvement, provider relations, and population health initiatives. About Maryland Care Management, Inc. (MCMI) Maryland ...

CareFirst

Care Manager (Remote)

Baltimore, MD · Remote

  • Medical

  • Retirement

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 ...

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

  • Medical

  • Retirement

... Management, Home Health, Discharge Coordination and/or Utilization Review. Preferred Qualifications: * Knowledge and experience with MCG * Experience working with Commercial and Federal Employee ...

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

  • Medical

  • Retirement

... review of inpatient level of care, managing the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and skills in utilization management, the ...

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All JobsUtilization Review JobsRemote Utilization Review Manager JobsRemote Utilization Review Manager Jobs in Maryland

Remote Utilization Review Manager information

What is a remote utilization review manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

What are the key skills and qualifications needed to thrive as a remote utilization review manager?

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.

What are some common challenges faced by a remote utilization review manager, and how can they be addressed?

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

What is the difference between Remote Utilization Review Manager vs Remote Utilization Review Nurse?

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

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 Remote Utilization Review Manager jobs in Maryland?

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

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

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

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

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

Remote Utilization Review Manager jobs near you
Infographic showing various Remote Utilization Review Manager job openings in Maryland as of August 2026, with employment types broken down into 83% Full Time, 13% Part Time, and 4% Contract. Highlights an 100% Remote job distribution.

Senior Director, Complex Care Management and Utilization Management - 2947

AbsoluteCare

Baltimore, MD • On-site, Remote

Full-time

Re-posted 18 days ago

Job description

  • This role will involve up to 40% Travel across AbsoluteCare locations
  • RN license preferred.
  • Certification in Case Management (CCM), Utilization Review Accreditation Commission (URAC), or related credentials is a plus.

Job Summary
This Senior Director role over Complex Care Management (CCM) and Utilization Management (UM) is a strategic senior leader position that is responsible for designing, implementing, and optimizing integrated care delivery models that improve health outcomes for medically and socially complex populations. This role oversees the national CCM and UM programs, ensuring alignment with at-risk value-based care principles, transitional care management, regulatory compliance, and operational excellence across all markets. Experience with delegated care management and/or utilization management from a health plan is a major plus.
Duties and Responsibilities
Program Oversight
  • Direct the implementation of high-intensity, member-centered care models that reduce avoidable utilization and improve quality of life.
  • Leads conversations with medical economics on understanding the financial impacts of both care management and utilization management programs.
  • Supports the build of useful daily management reports to help support local managers in managing their team's productivity and effectiveness.
  • Develops materials and leads a monthly overview meeting for key executives to talk about strategic direction of both CCM and UM programs and executes on the strategy.
    - Ensure compliance with NCQA standards and other regulatory requirements for UM and care coordination services.
  • Supervises, leads a CM Program Manager, TCM program lead , two Clinical Educators, and three centralized Community Team Care Managers (total of 4-7 direct reports).
Operational Excellence
  • Monitor and optimize care and utilization management workflows, staffing models, and performance metrics across CM and UM teams including bed management, admissions, and ED utilization.
    - Lead the development of efficient and effective clinical training programs, documentation standards, policies and procedures and performance management systems to support clinical and non-clinical staff.
Team Development
  • Build and mentor a high-performing interdisciplinary team including care managers, behavioral health clinicians, UM nurses, and community health workers.
    - Foster a culture of accountability, innovation, and continuous improvement.
  • Responsible for working with site leaders to develop and implement clinical engagement/retention action plans that enhance staff satisfaction survey results
Stakeholder Engagement
  • Serve as a key liaison with payer and health system hospital partners, regulatory bodies, and internal stakeholders to ensure transparency, compliance, and shared success.
  • -Develop strong working relationships with market UM/CM leaders, engagement leaders and VPs that influence optimal clinical engagement AND clinical model execution.
    - Represent the organization in strategic discussions with external partners and at industry forums.

Minimum Qualifications
  • Bachelor's degree in Nursing, Public Health, Health Administration, or related field required; Master's degree preferred.
    - Minimum of 7-10 years in a Senior Director or Vice President role overseeing complex care management, transitional care management or utilization management in a managed care or at-risk value-based medical group environment.
    - Proven track record of leading large-scale, multi-site clinical operations, driving cost savings, achieving affordability targets and improving patient outcomes.
    - Deep understanding of Medicaid/Medicare populations, transitional care management leading to readmission reduction, , and integrated care delivery models.
    - Strong leadership, communication, and change-management skills.
  • Knowledge and experience working with ZeOmega/Jiva electronic health record is a plus, but not required.
  • Must be willing to travel across our different markets to interact with corporate leadership team, managers, and front-line staff.
Preferred Certifications
  • RN license preferred.
  • Certification in Case Management (CCM), Utilization Review Accreditation Commission (URAC), or related credentials is a plus.

Working conditions
This job operates in a remote location from your home location. This role requires a dedicated, quiet workspace with the ability to adhere to HIPAA and other privacy policies. A reliable and high-speed Wi-Fi connection or home internet is required to perform the essential functions of this role.
Physical requirements
  • Ability to communicate clearly and exchange accurate information constantly.
  • Ability to remain stationary for long periods of time.
  • Repetitious movements.
  • Constantly operates computer, keyboard, copy and fax machine, phone, and other general office equipment

Direct reports
Care Management Program (lead) Manager, Transitional Care Manager Program (Lead) Manager, Centralized CCM, Clinical Educator
Company Description:
Why Work at AbsoluteCare?
At AbsoluteCare, we serve the most vulnerable individuals in America. These are our neighbors, people who are at higher risk for disease or who have multiple, complex, chronic illnesses. Often, they deal with an unequal healthcare system and wind up seeking basic care from emergency rooms. We take these patients out of those spaces and turn them into members: people who are entitled to some of the best, most focused care this country has to offer.
We call this "care beyond medicine." We have turned the doctor's office into a comprehensive care center. Here, we surround our members with a core care team of doctors, nurses, social workers, and medical assistants who have the time and skills to get to know our members' needs. We make the most important services available to our members under one roof. This includes a pharmacy, X-rays, a blood lab, nutrition services, urgent care, and much more.
We don't stop at our four walls. We engage members in the communities where we all live to find the people who need us most. Through these community care teams, we remove the barriers to healthcare that so many people face daily. And it works.
Our unique care is guided by our core values of accountability, caring, trust, and teamwork. We call it ACT2.
AbsoluteCare, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, age, disability, genetics, protected Veteran status, or any other characteristic protected by law or policy.

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