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Remote Utilization Review Nurse Jobs in Silver Spring, MD

RELI Group Inc.

Medical Review Nurse III

Baltimore, MD · On-site +1

$80K - $95K/yr

A minimum of three (3) or more years' experience in medical/utilization medical record review ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...

RELI GROUP INC

Medical Review Nurse III

Baltimore, MD · Remote

A minimum of three (3) or more years' experience in medical/utilization medical record review ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...

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 ...

Global Alliant Inc

Clinical Analyst

Baltimore, MD · Remote

Remote Job Duration: Contract / FTE Client: Federal Criteria- Need US citizenship because of ... Utilization Management / Utilization Review / Prior Authorization * Clinical or healthcare ...

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 ...

CareFirst

Care Manager (Remote)

Baltimore, MD · Remote

... Utilization Review, Disease Management or other direct patient care experience. Preferred ... CCM/ACM or other RN Board Certified certification in case management. * Previous experience with ...

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

... RN - Registered Nurse in MD, VA or Washington, DC Experience: 5 years clinically related experience working in Care Management, Home Health, Discharge Coordination and/or Utilization Review.

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 ...

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Remote Utilization Review Nurse information

See Silver Spring, MD salary details

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How much do remote utilization review nurse jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for remote utilization review nurse in Silver Spring, MD is $43.71, according to ZipRecruiter salary data. Most workers in this role earn between $34.52 and $50.19 per hour, depending on experience, location, and employer.

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

To thrive as a Remote Utilization Review Nurse, you need a current RN license, clinical experience, and a solid understanding of medical necessity criteria and healthcare regulations. Familiarity with utilization management software, EHR systems, and certifications like CCM or URAC are highly valued. Strong analytical thinking, attention to detail, and effective communication skills enable success in evaluating clinical documentation and collaborating with providers remotely. These skills and qualifications are essential to ensure efficient, compliant care decisions that optimize patient outcomes and resource use.

How does a remote utilization review nurse collaborate with physicians and other healthcare team members while working remotely?

As a Remote Utilization Review Nurse, collaboration with physicians, case managers, and other healthcare professionals is primarily conducted through secure digital platforms such as email, video conferencing, and electronic health record systems. Effective communication is essential to discuss patient care plans, clarify medical necessity, and ensure compliance with utilization policies. Nurses in this role often participate in virtual meetings or case conferences to present findings and recommendations. Building strong working relationships remotely requires proactive communication, responsiveness, and familiarity with digital collaboration tools.

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

AspectRemote Utilization Review NurseRemote Case Manager
CertificationsRN license, possibly CCM or UR certificationsRN license, CCM or case management certifications
Work EnvironmentHealthcare facilities, insurance companies, telehealthInsurance companies, healthcare organizations, telehealth
Job FocusReview medical necessity, approve or deny servicesCoordinate patient care, arrange services, discharge planning

Remote Utilization Review Nurses primarily evaluate medical necessity for services, while Remote Case Managers coordinate patient care and discharge planning. Both roles require nursing credentials and work in healthcare or insurance settings, but their core responsibilities differ. Understanding these distinctions helps job seekers find the best fit for their skills and career goals.

What is a remote utilization review nurse?

A Remote Utilization Review Nurse is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments, typically from a remote location such as their home. They review patient medical records, apply clinical guidelines, and collaborate with providers and insurance companies to ensure patients receive appropriate care while managing healthcare costs. This role often involves making coverage determinations, conducting pre-authorizations, and participating in appeals processes. Remote Utilization Review Nurses play a critical role in improving patient outcomes and resource allocation within the healthcare system.

What does a remote utilization review nurse do?

As a remote utilization nurse, your duties are to work from home or a remote location to review patient medical records and prepare a range of paperwork for different types of actions a hospital or health care provider can take. Your responsibilities are to determine patient coverage, carry out denial of service authorizations, and negotiate different treatment options and hospital stay length for patients. You rely on your knowledge of treatment options and diseases to determine the level of appropriate care for a patient. Because you telecommute, you also need good technical skills.

More about Remote Utilization Review Nurse jobs
What are the most commonly searched types of Utilization Review Nurse jobs in Silver Spring, MD? The most popular types of Utilization Review Nurse jobs in Silver Spring, MD are:
What are popular job titles related to Remote Utilization Review Nurse jobs in Silver Spring, MD? For Remote Utilization Review Nurse jobs in Silver Spring, MD, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Nurse jobs in Silver Spring, MD look for? The top searched job categories for Remote Utilization Review Nurse jobs in Silver Spring, MD are:
What cities near Silver Spring, MD are hiring for Remote Utilization Review Nurse jobs? Cities near Silver Spring, MD with the most Remote Utilization Review Nurse job openings:
Remote Utilization Review Nurse jobs near you
Infographic showing various Remote Utilization Review Nurse job openings in Silver Spring, MD as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 17% Part Time, and 3% Contract. Highlights an 89% Physical, 4% Hybrid, and 7% Remote job distribution, with an average salary of $90,917 per year, or $43.7 per hour.

Medical Review Nurse III

RELI Group Inc.

Baltimore, MD • On-site, Remote

$80K - $95K/yr

Full-time

Re-posted 11 days ago

Job description

About Us:
At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact-whether we're supporting data-driven decisions, modernizing systems or safeguarding critical programs.
Perform automated and complex medical record and claim reviews to make coverage determinations based on applicable Medicare coverage policies and payment rules, coding guidelines, National and Local Coverage Determinations, utilization/practice guidelines, and clinical review judgment. Provides professional assessment, planning, coordination, implementation, and reporting of complex data to support the Recovery Auditor Validation Contract (RVC).
Essential Functions
  • Perform accuracy review of automated and complex Medicare medical record and claims review in accordance with all State and Federal mandated regulations/guidelines.
  • Perform accuracy reviews as a Special Study requested by CMS.
  • Document findings for each claim in a clear and concise manner.
  • Compile a report explaining the claim reviews, including identified patterns, inappropriate determinations, as well as recommendations.
  • Reasonably determines appropriateness to consult a Subject Matter Expert (SME) for clarification.
  • Perform medical record reviews in response to RAC disputes/disagrees with the RVC review decisions.
  • Perform accuracy review of the New Issue Proposal for appropriate regulations, references, policies, and edit parameters. Compile a report of analysis and recommendations to submit to CMS.
  • Perform New Issue Quality Assurance Review for accuracy of all criteria and references.
  • Consistently meet or exceed productivity and accuracy standards of 95% minimum IRR established by the customer and/or the Company.
  • Report problems to the Medical Review Manager (MRM) and Project Manager (PM) regarding unique record or process issues.
  • Maintain security and confidentiality of medical records and Protected Health Information (PHI) and Personally Identifiable Information (PII).
  • Consistently meet attendance standards established by the Company and follows the telecommuting policy.
  • Interact appropriately with peers, co-workers, other Contractors, and the customer, when necessary. Contribute to building a positive team spirit.
  • On occasions may be asked by the MRM or PM to assist with development of training and/or resource materials.
  • May be asked to assist with precepting of new Medical Review Nurses (MRNs).
  • Perform other duties and projects as assigned.

Required Education and Experience
  • Registered Nurse, with a current unobstructed license to practice nursing in the United States. Graduate of a Board approved Registered Nursing program.
  • A Bachelor's Degree in Nursing (BSN) or other related field is preferred.
  • Certification in coding highly preferred.
  • A minimum of three (3) years clinical experience in an acute care hospital, skilled nursing facility, and/or an office/clinic-based medical practice.
  • A minimum of three (3) or more years' experience in medical/utilization medical record review particularly with Medicare and/or Medicaid.
  • Proficiency in research, interpretation, and application of Medicare, Medicaid, and local healthcare regulations and policies.
  • Must be proficient in Microsoft Office Suite such as Outlook, Excel and Word.

Skills & Abilities
  • Ability to work independently and maintain an elevated level of concentration.
  • Capable of consistency, speed, and accuracy of task.
  • Ability to read, analyze, and interpret physician documentation.
  • One year or more of utilizing InterQual and /or Milliman guidelines against inpatient services experience is preferred.
  • Ability to communicate clearly and professionally with all levels of the organization, both written and verbal.
  • Ability to work well in a remote team environment, to collaborate with others, and interface with team members internal and external to the organization.
  • Establishes and maintains effective professional relationships with internal and external stakeholders.
  • Must be able to adapt to organizational change.
  • Must be proficient in Microsoft Office Suite such as Outlook, Excel, and Word.
  • Flexibility and ability to plan, prioritize, and execute multiple tasks in a fast-paced environment.
  • Self-motivated, well-organized, and detail oriented.
  • Ability to maintain a high level of confidentiality and integrity

EEO Employer:
RELI Group is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.
HUBZone:
We encourage all candidates who live in a HUBZone to apply. You can check to see if your address is located in a HUBZone by accessing the SBA HUBZone Map.
The annual salary range for this position is $80,000 to $95,000. Actual compensation will depend on a range of factors, including but not limited to the individual's skills, experience, qualifications, certifications, location, other business and organizational needs, and applicable employment laws. The estimate displayed represents the typical salary range for this position and is just one component of the total compensation package for employees. RELI Group provides a variety of additional benefits to its employees. For additional details on the benefits that RELI Group offers click here

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