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Remote Utilization Review Rn Jobs in Maryland (NOW HIRING)

CareFirst

Care Manager (Remote)

Baltimore, MD · Remote

We are looking for an experienced Registered Nurse to work remotely within the greater Baltimore ... Utilization Review, Disease Management or other direct patient care experience. Preferred ...

RELI Group Inc.

Medical Review Nurse III

Baltimore, MD · On-site +1

$80K - $95K/yr

... Determinations, utilization/practice guidelines, and clinical review judgment. Provides ... Registered Nurse, with a current unobstructed license to practice nursing in the United States.

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

The Clinical Navigator (RN) conducts concurrent review of inpatient level of care, managing the ... Utilizing experience and skills in utilization management, the Clinical Navigator will leverage ...

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

The Clinical Navigator (RN) conducts concurrent review of inpatient level of care, managing the ... Utilizing experience and skills in both care management and utilization management, the Clinical ...

Corvel

Telephonic Case Manager I

Nottingham, MD · Remote

$63K - $95K/yr

This is a remote role. This position requires a California RN Nursing License. ESSENTIAL FUNCTIONS ... Strong cost containment background, such as utilization review or managed care helpful

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Remote Utilization Review Rn information

See Maryland salary details

$20

$41

$66

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

As of Jul 27, 2026, the average hourly pay for remote utilization review rn in Maryland is $41.04, according to ZipRecruiter salary data. Most workers in this role earn between $32.45 and $47.12 per hour, depending on experience, location, and employer.

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

To excel as a Remote Utilization Review RN, you need a valid RN license, strong clinical judgment, and knowledge of utilization management principles. Familiarity with electronic medical records (EMR), utilization management software, and guidelines such as InterQual or MCG is typically required. Outstanding attention to detail, critical thinking, and effective communication skills help you collaborate with healthcare teams and advocate for appropriate patient care. These competencies are crucial for ensuring medical necessity, regulatory compliance, and optimal resource use in a remote setting.

What is a Remote Utilization Review RN?

A Remote Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services provided to patients, typically working from a remote location. They review medical records, apply clinical guidelines, and collaborate with healthcare providers to ensure patients receive the right care at the right time. Their work helps manage healthcare costs and improves patient outcomes by preventing unnecessary treatments or hospital stays. Remote Utilization Review RNs often work for insurance companies, hospitals, or healthcare organizations, and use secure digital platforms to conduct their reviews.

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

AspectRemote Utilization Review RnRemote Case Manager Rn
CertificationsRN license, Utilization Review certification (e.g., URAC)RN license, Case Management certification (e.g., CCM)
Work EnvironmentReviewing medical records, insurance policies, telehealth platformsCoordinating patient care, discharge planning, telehealth
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance providers, healthcare agencies

Remote Utilization Review Rns primarily focus on evaluating medical necessity for insurance coverage, while Remote Case Manager Rns coordinate patient care and discharge planning. Both roles require RN licensure and involve telehealth work, but they serve different functions within healthcare and insurance industries.

What are some common challenges Remote Utilization Review RNs face when working from home, and how can they be addressed?

Remote Utilization Review RNs often encounter challenges such as maintaining clear communication with interdisciplinary teams, managing time efficiently, and staying updated on changing payer guidelines. To address these challenges, it's important to establish consistent check-ins with team members via video or chat platforms, use digital tools to organize and prioritize caseloads, and participate in ongoing training sessions provided by employers. Adhering to a structured daily routine and leveraging available technology can help ensure productivity and high-quality reviews while working remotely.
What are popular job titles related to Remote Utilization Review Rn jobs in Maryland? For Remote Utilization Review Rn jobs in Maryland, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Maryland look for? The top searched job categories for Remote Utilization Review Rn jobs in Maryland are:
What cities in Maryland are hiring for Remote Utilization Review Rn jobs? Cities in Maryland with the most Remote Utilization Review Rn job openings:
Remote Utilization Review Rn jobs near you
Infographic showing various Remote Utilization Review Rn job openings in Maryland as of July 2026, with employment types broken down into 71% Full Time, 13% Part Time, and 16% Contract. Highlights an 42% Physical, 4% Hybrid, and 54% Remote job distribution, with an average salary of $85,356 per year, or $41 per hour.
Clinical Guide Part A: Utilization Management Nurse

Clinical Guide Part A: Utilization Management Nurse

Devoted Health

Nottingham, MD • On-site, Remote

$85K - $95K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 18 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 299 rated insurance

Job description

Job Description
Schedule:
The weekly schedule choice is either Monday - Friday 10am-7pm EST OR Tuesday - Saturday 9am-6pm EST
A bit about this role:
The Clinical Guide Part A will be part of the Utilization Management team, responsible for inpatient, behavioral health, and/or post-acute authorization review in alignment with CMS and Medicare Advantage regulations.
Reviews medical records to evaluate the medical necessity and appropriateness of requested inpatient and/or post-acute services in accordance with established clinical criteria and CMS guidelines.
Your Responsibilities and Impact will include:
  • Review Medical Records: Conduct prospective (pre-service), concurrent, and retrospective utilization review to evaluate medical necessity, appropriate level of care (Inpatient vs. Observation), and post-acute services in accordance with established clinical criteria and CMS guidelines.
  • Evaluate Treatment Plans: Assess the appropriateness, timing, and setting of requested services, ensuring alignment with medical necessity criteria and Medicare Advantage requirements. Recommend alternative levels of care when clinically appropriate.
  • Inpatient & Behavioral Health Review: Perform initial, concurrent, and discharge reviews for inpatient and behavioral health admissions. Ensure admission status accuracy and regulatory compliance with CMS timeliness (TAT) standards.
  • Post-Acute Review: Conduct initial authorization and concurrent review for post-acute services (SNF, LTACH, ARU, Home Health), evaluating ongoing medical necessity and appropriate length of stay. Issue NOMNC when coverage criteria are no longer met.
  • Medical Director Collaboration: Refer cases that do not meet criteria to the Medical Director for secondary review and final determination. Prepare clinical summaries and coordinate peer-to-peer (P2P) discussions. Manage authorization reopen requests as appropriate.
  • Resource Stewardship: Monitor utilization of inpatient and post-acute services to promote appropriate resource use while maintaining high-quality, member-centered care.
  • Regulatory & Documentation Compliance: Maintain accurate, defensible documentation of all determinations. Ensure adherence to CMS regulations, Medicare Advantage requirements, and internal compliance standards.

Required skills and experience:
  • Unrestricted RN license with a minimum of 4 years of clinical experience.
  • Minimum 3 years of Utilization Management or Inpatient UR experience within a health plan or hospital setting.
  • Strong knowledge of CMS regulations and Medicare Advantage requirements.
  • Experience preparing cases for Medical Director review
  • Able to work in a fast paced environment that is constantly evolving.

Desired skills and experience:
  • Experience with AI/LLM
  • Certified in InterQual

#LI-Remote
#LI-DS1
Salary Range: $85,000-$95,000 / year
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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