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Remote Utilization Review Rn Jobs in Maryland (NOW HIRING)

J29 Inc.

Nurse SME

Millersville, MD · On-site +1

$100K - $120K/yr

Remote About J29 J29 is an employee centered healthcare management consulting company that ... Experience conducting clinical audits, medical record reviews, claims reviews, utilization reviews ...

Varsity Tutors

NCLEX-RN Tutor

Rockville, MD · Remote

$18 - $40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Varsity Tutors

NCLEX-RN Tutor

Bowie, MD · Remote

$18 - $40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Varsity Tutors

NCLEX-RN Tutor

College Park, MD · Remote

$18 - $40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Varsity Tutors

NCLEX-RN Tutor

Baltimore, MD · Remote

$18 - $40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Varsity Tutors

NCLEX-RN Tutor

Laurel, MD · Remote

$18 - $40/hr

Adapts instruction using UWorld, Kaplan, or ATI practice question banks, content review materials, and test-taking strategy workshops to support BSN and ADN graduates preparing for registered nurse ...

Cinqcare

Registered Nurse

Laurel, MD · Remote

Deploys Remote Patient Monitoring and Patient Self Reporting for High-Risk Chronic Conditions ... The RN will establish the business strategy and roadmap: (1) improve outcomes for Grace at Home ...

SalvoHealth

Bi-Lingual, RN Care Coordinator

Annapolis, MD · On-site +1

$25 - $26/hr

... Remote Patient Monitoring ("RPM") to bill under the patient's insurance. This is a major step ... reviewing applications, analyzing resumes, or assessing responses and identifying potential ...

Edwards Lifesciences Corporation

This position offers the flexibility of being fully remote, but the selected candidate must be ... Author and/or review complaint conclusions/closure statements and customer letters. May assist with ...

Harris

$10/hr

EXAMPLE: Chart Review 8 min Outreach Attempts: 6 min Actual Call:11 min Care Coordination:9 min ... Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no ...

Harris

$10/hr

EXAMPLE: Chart Review 8 min Outreach Attempts: 6 min Actual Call:11 min Care Coordination:9 min ... Current COMPACT license to practice as an RN/ LVN/LPN held in current state of residence with no ...

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Showing results 21-40

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

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 Sep 8, 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 September 2026, with employment types broken down into 2% As Needed, 83% Full Time, 8% Part Time, and 7% Contract. Highlights an 100% Remote job distribution, with an average salary of $85,356 per year, or $41 per hour.

Nurse SME

J29 Inc.

Millersville, MD • On-site, Remote

$100K - $120K/yr

Full-time

Posted 6 days ago

Job description

*This position is contingent upon the successful award of the associated contract. Employment is not guaranteed until the contract is awarded, and the position is officially activated. Job responsibilities and requirements are subject to change.
Position: Nurse Subject Matter Expert (SME)
Location: Remote
About J29
J29 is an employee centered healthcare management consulting company that specializes in processing, reviewing, and analyzing medical claims, records, disputes, and audits. Established in 2017, J29 prides itself on its employee centric culture and high employee retention rates that allow us to ensure that we are creating a working environment that prioritizesthe employeeexperience. Our team brings corporate performance that stretches to various areas where we can provide our clinical, healthcare policy, and complianceexpertisethrough our support to health and human service programs at the State, Federal, and Commercial levels.
Overview
J29 is seeking a highly experienced Nurse Subject Matter Expert (SME) in support of an potential upcoming contract. The Nurse SME will serve as a senior clinical resource, providing subject matter expertise in support of program integrity initiatives, audits, investigations, data analysis, healthcare reviews, fraud, waste, and abuse (FWA) prevention efforts. This individual will collaborate with internal teams and external stakeholders to evaluate healthcare data, review medical records and claims, identify vulnerabilities, and develop recommendations that support compliance, quality, and operational effectiveness. The Nurse SME will leverage extensive clinical experience and analytical expertise to support project objectives and improve healthcare program outcomes.
Role & Responsibilities
  • Provides clinical support to other functional areas (e.g., audits, complaints, data analysis, investigations, requests for information, predictive modeling, and vulnerabilities) in need of subject matter expertise.
  • Works directly with the client and appropriate stakeholders, health plans, pharmacy benefit managers, other contractors, law enforcement, providers, suppliers, prescribers, and pharmacies to build partnerships, support data sharing, develop tools, and references to support program integrity initiatives.
  • Initiates and contributes to the conceptual design, methodologies, and implementation of projects, as well as assist with project execution as needed.
  • May provide educational programs as necessary to meet project goals, combat potential fraud, waste, and abuse, and promote high quality, safe, and effective medication use.
  • Develop solutions, alternative practices, or strategies to detect and prevent FWA.
  • Gather and organize information about a problem to be solved or the procedure or process to be improved.
  • Analyze financial, operational, and performance data, information, and other forms of evidence.
  • Participate in audit activities, such as performing audits and/or reviews of healthcare services based on billing and medical records, compendia, and criteria to evaluate the appropriateness of the patient encounters.
  • Use nursing expertise to translate requirements among other professionals.
  • Identify and utilize appropriate techniques in vetting data and information.
  • Identify and aid in the development of best practices for conducting audits, analytics, and program vulnerability studies.
  • Review and analyze encounter data, fee-for-service claims, enrollment data, prescription drug event records, and other data sources in providing advice, input, and recommendations.

Experience / Expertise
  • Active, unrestricted Registered Nurse (RN) license in at least one U.S. state or territory.
  • Bachelor's degree in Nursing, Healthcare Administration, Public Health, or a related healthcare field required.
  • 10+ years of clinical and healthcare industry experience, including medical record review, clinical auditing, risk adjustment, payment integrity, quality improvement, or healthcare program oversight.
  • Demonstrated expertise in reviewing and interpreting medical records, claims data, encounter data, and clinical documentation.
  • Strong knowledge of Hierarchical Condition Categories (HCCs), risk adjustment methodologies, risk score validation, and coding/documentation requirements.
  • Experience supporting or conducting Risk Adjustment Data Validation (RADV) audits and reviews.
  • Knowledge of Health Risk Assessments (HRAs) and their role in risk adjustment and population health initiatives.
  • Experience evaluating and analyzing encounter data for completeness, accuracy, and compliance.
  • Working knowledge of CMS STAR Ratings, quality performance measures, and healthcare quality improvement initiatives.
  • Familiarity with supplemental benefits, healthcare utilization trends, and member-focused care programs.
  • Knowledge of Medical Loss Ratio (MLR) concepts and their impact on healthcare operations and performance.
  • Experience identifying potential fraud, waste, abuse, compliance risks, documentation gaps, and operational vulnerabilities through clinical review and data analysis.
  • Strong analytical and critical thinking skills with the ability to interpret clinical, operational, and financial data and provide actionable recommendations.
  • Experience collaborating with health plans, providers, healthcare organizations, and cross-functional teams to support program objectives.
  • Excellent written and verbal communication skills, including the ability to summarize clinical findings and present recommendations to stakeholders.

Preferred Qualifications
  • Experience supporting healthcare program integrity, fraud, waste, and abuse (FWA) detection and prevention efforts.
  • Experience conducting clinical audits, medical record reviews, claims reviews, utilization reviews, or healthcare investigations.
  • Knowledge of healthcare reimbursement methodologies, claims processing, and healthcare data analytics.
  • Experience working with health plans, providers, suppliers, pharmacies, or other healthcare stakeholders.
  • Familiarity with healthcare compliance requirements and quality improvement methodologies.
  • Experience developing educational materials, training programs, guidance documents, or best-practice recommendations.
  • Professional certifications such as CPHQ, CCM, CPMA, CHC, or other relevant healthcare certifications preferred.
  • Experience supporting government, commercial, or managed healthcare programs preferred.

Salary: $100,000-120,000 annually based on years of experience related to the role.
J29, Inc. is committed to hiring and retaining a diverse workforce. We are proud to be an Equal Opportunity/Affirmative Action Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. J29, Inc. is a proud Veteran friendly employer.
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About J29

Sourced by ZipRecruiter

Industry

Business management consulting

Company size

1 - 10 Employees

Headquarters location

Millersville, MD, US

Year founded

2017

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