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Remote Utilization Review Rn Jobs in Maryland (NOW HIRING)

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

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 ...

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 ...

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 ...

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 Aug 17, 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 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 are the key skills and qualifications needed to thrive as a remote utilization review RN?

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 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 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 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 August 2026, with employment types broken down into 84% Full Time, 11% Part Time, and 5% Contract. Highlights an 100% Remote job distribution, with an average salary of $85,356 per year, or $41 per hour.

Senior Director, Complex Care Management and Utilization Management - 2947

AbsoluteCare

Baltimore, MD • On-site, Remote

Full-time

Re-posted 16 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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