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Remote Utilization Review Rn Jobs in Greenbelt, MD

Maximus

Consultant - Medical (Case Reviewer 2)

VA · On-site +1

This is a remote opportunity. The Consultant will review WCMSA case submissions in support of the ... Active, valid RN licensure. - Medicare Set-Aside Certified Consultant (MSCC) certification ...

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 ...

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Remote Utilization Review Rn information

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

As of Aug 18, 2026, the average hourly pay for remote utilization review rn in Greenbelt, MD is $42.61, according to ZipRecruiter salary data. Most workers in this role earn between $33.65 and $48.94 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 Greenbelt, MD?

For Remote Utilization Review Rn jobs in Greenbelt, MD, the most frequently searched job titles are:

What job categories do people searching Remote Utilization Review Rn jobs in Greenbelt, MD look for?

The top searched job categories for Remote Utilization Review Rn jobs in Greenbelt, MD are:

What cities near Greenbelt, MD are hiring for Remote Utilization Review Rn jobs?

Cities near Greenbelt, MD 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 Greenbelt, MD as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 13% Part Time, 4% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $88,624 per year, or $42.6 per hour.

Utilization Review Specialist (BCBA Licensee)

System One

Baltimore, MD • Remote

$51/hr

Contractor

Medical, Dental, Vision, Life, Retirement

Re-posted 25 days ago

Job description

Job Title: Utilization Review Specialist (BCBA Licensee) Location: Baltimore, MD (Remote – offsite) Type: Contract To Hire Compensation: $51/hr (W2) Work Model: 100% Remote Must be Licensed in one of the 3 states: MD, VA or Washington D.C.

Overview Utilizing key principles of utilization management, the Utilization Review Specialist (BCBA Licensee) performs prospective, concurrent, and retrospective reviews to determine authorization, medical necessity, and appropriateness of Applied Behavior Analysis (ABA) services. This role leverages clinical expertise in behavior analysis and evidence-based ABA practices to evaluate treatment plans, service intensity, and clinical outcomes for individuals with Autism Spectrum Disorder (ASD) and other developmental or behavioral diagnoses.

Responsibilities

  • Perform prospective, concurrent, and retrospective reviews to determine authorization, medical necessity, and appropriateness of ABA services.
  • Review ABA treatment requests (initial, concurrent, and retrospective) for clinical appropriateness and benefit coverage.
  • Evaluate ABA treatment plans, goals, supervision models, requested service intensity, and progress/outcomes using behavior analytic principles and evidence-based practices.
  • Analyze clinical documentation, benefit plans, mandates, and medical/behavioral health policies to support determinations related to ABA services.
  • Determine medical necessity and appropriateness by referencing applicable regulatory mandates, contracts/benefit information, and clinical guidelines and policies.
  • Conduct research and analysis of behavioral health conditions, ABA treatment methodologies, and emerging practices within the field of behavior analysis.
  • Collaborate with internal clinical leadership (e.g., medical directors) and cross-functional partners (e.g., provider and member services) to support appropriate benefit application and case decision-making.
  • Coordinate as needed with internal partners and providers related to benefit determinations and case-related follow-up.
  • Make appropriate referrals and contacts as needed; support members and providers with alternative care options when appropriate.
  • Provide guidance to providers and internal teams regarding ABA best practices, documentation standards, and authorization requirements.
  • Develop and present educational materials on ABA topics, treatment trends, and case learnings to internal stakeholders.

Requirements

  • Master’s Degree or higher in Behavior Analysis, Psychology, Education, or a related field
  • Board Certified Behavior Analyst (BCBA) certification — active and in good standing
  • Active state licensure as a Behavior Analyst (if required in the practicing state) — required where applicable
  • 3–5+ years of clinical ABA experience
  • Direct patient care experience delivering ABA services (e.g., in-home, center-based, school-based, community)
  • Demonstrated experience developing ABA treatment plans, including:
    • Functional behavior assessment/analysis (FBA/FA) and clinical documentation
    • Individualized goal development and measurement strategies
    • Treatment plan updates based on data and clinical progress
    • Caregiver training and/or supervision/model oversight (as applicable)
  • Strong written and interpersonal communication skills; ability to communicate effectively with providers and internal stakeholders
  • Strong clinical assessment and analytical skills with the ability to make sound, timely determinations
  • Ability to manage competing priorities and maintain organization in a fast-paced environment
  • Proficiency with web-based tools and Microsoft Office (Word, Excel, PowerPoint)

Preferred Qualifications

  • Prior experience in utilization management, care management, or payer-side review of ABA services
  • Working knowledge of managed care and health delivery systems
  • Familiarity with clinical guidelines, medical policies, accreditation, and regulatory standards (e.g., NCQA and comparable standards)
  • Comfort working in a web-based systems environment and using online resources to support clinical review decisions

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.

System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.

#M-1 #LI-AJ1 Ref: #851-Rockville-S1