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Remote Utilization Review Nurse Jobs in Silver Spring, MD

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

... 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. Preferred Qualifications:

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 ...

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

The Clinical Navigator (RN) is responsible for utilization management and concurrent review of inpatient care to ensure members receive medically necessary services at the appropriate level of care.

Maryland Physicians Care

Medical Director

Linthicum, MD · On-site +1

$266K - $315K/yr

Round with concurrent review nurses on a regular basis to discuss inpatient members as determined ... Experience in utilization review and management practices, processes, and procedures. * Knowledge ...

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.

Centerbrite

BCBA (Part-time) (Remote)

Fairfax, VA · Remote

$80 - $110/hr

BCBA (Board Certified Behavior Analyst) - Part-time $80110/hr Flexible Schedule Hybrid (Remote + In ... Own documentation quality , utilization reviews, and oversight of treatment plans * Supervise RBTs ...

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Remote Utilization Review Nurse information

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$71

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

As of Sep 7, 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 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.

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.

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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, 81% Full Time, 14% Part Time, 1% Temporary, and 3% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $90,917 per year, or $43.7 per hour.

Utilization Management Specialist

CYNET SYSTEMS

Baltimore, MD • Remote

$19 - $24/hr

Contractor

Re-posted 23 days ago

Job description

Job Overview:

Pay Range: $19.66hr - $24.66hr

Requirement/Must Have:

  • 5+ years Clinical nursing experience.
  • 2+ years Care Management.
  • Bachelor's Degree in Nursing.

Responsibilities:

  • Determines medical necessity and appropriateness by referencing regulatory mandates, contracts, benefit information, Milliman Care Guidelines, Apollo Guidelines, ASAM, Medicare Guidelines, Federal Employee Program and Policy Guidelines, Medical Policy, and other accepted medical/pharmaceutical references.
  • Conducts research and analysis of pertinent diseases, treatments and emerging technologies, including high cost/high dollar services to support decisions and recommendations made to the medical directors.
  • Makes appropriate referrals and contacts as appropriate. Offers assistance to members and providers for alternative settings for care.

Nice to Have:

  • Working knowledge of managed care and health delivery systems.
  • Thorough knowledge of clinical guidelines, medical policies and accreditation and regulatory standards.
  • Working knowledge of IT and Medical Management systems.

Skills:

  • Effective written and interpersonal communication skills.
  • Strong assessment skills with the ability to make rapid connection with members.
  • Ability to work effectively with large amounts of confidential member data and PHI.
  • Ability to multitask, prioritize and maintain a dynamic personal organization system.
  • Proficient in the use of web-based technology and Microsoft Office applications.

Qualification And Education:

  • RN - Registered Nurse - State Licensure And/or Compact State Licensure Upon Hire.
  • LPN - Licensed Practical Nurse - State Licensure.
  • CNS - Clinical Nurse Specialist Preferred.

Founded in 2010 and headquartered in the Washington, DC metro area, Cynet Systems Inc. is a leading staffing and recruiting powerhouse. Proudly recognized as a nationally and locally certified diversity firm, Cynet delivers agile, scalable talent solutions across industries. With an active footprint in all 50 U.S. states and Canada, we support thousands of consultants through our expansive, high-performing recruitment engine operating across North America and Asia—ensuring speed, quality, and consistency in every hire.
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About Cynet Systems

Sourced by ZipRecruiter

Cynet Systems Inc is a staffing and recruiting corporation nestled in Ashburn, VA, USA. Established in 2010, the company operates within the Information Technology and Services sector, specializing in providing effective workforce solutions to different business needs, including IT consulting, direct hire, and contract staffing services. Through the years, Cynet Systems has built an impressive portfolio, going beyond borders and expanding its operations internationally in Canada and India. Rooted in its core values of teamwork, leadership, and commitment, Cynet Systems helps businesses unlock their full potential by providing versatile and competent professionals that perfectly align with their needs. Fueled by their unwavering mission to deliver top-tier talent to businesses worldwide, Cynet Systems garnered various recognitions including SIA's fastest-growing staffing firms and Best Place to Work in Virginia for 2019.

Industry

It services

Company size

501 - 1,000 Employees

Headquarters location

Sterling, VA, US

Year founded

2010

Social media

Twitter

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