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Remote Utilization Review Rn Jobs in Silver Spring, MD

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

Experience: 5 years clinically related experience working in Care Management, Home Health, Discharge Coordination and/or Utilization Review. Licenses/Certifications Upon Hire Required: * RN - ...

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 ...

V-Tech Solutions Inc.

RN Care Manager

Washington, DC · Remote

$36.32 - $46/hr

The RN Care Manager assesses member needs, develops and monitors individualized care plans ... Identify gaps in care and address over- or under-utilization of services * Document care management ...

Central Intelligence Agency

Registered Nurse

Washington, DC · On-site +1

$103K - $112K/yr

Learn more about this agency Duties Help As a Registered Nurse for CIA, you will have diverse and ... Review our benefits Eligibility for benefits depends on the type of position you hold and whether ...

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All JobsUtilization Review Rn JobsRemote Utilization Review Rn JobsRemote Utilization Review Rn Jobs in Silver Spring, MD

Remote Utilization Review Rn information

See Silver Spring, MD salary details

$22

$43

$71

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

As of Jul 7, 2026, the average hourly pay for remote utilization review rn 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 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 Silver Spring, MD? For Remote Utilization Review Rn jobs in Silver Spring, MD, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Rn jobs in Silver Spring, MD look for? The top searched job categories for Remote Utilization Review Rn jobs in Silver Spring, MD are:
What cities near Silver Spring, MD are hiring for Remote Utilization Review Rn jobs? Cities near Silver Spring, 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 Silver Spring, MD as of July 2026, with employment types broken down into 81% Full Time, 17% Part Time, and 2% Contract. Highlights an 39% Physical, 6% Hybrid, and 55% Remote job distribution, with an average salary of $90,917 per year, or $43.7 per hour.
Medical Review Nurse III

Medical Review Nurse III

RELI Group Inc.

Baltimore, MD • On-site, Remote

$80K - $95K/yr

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

About Us:
At RELI Group, our work is grounded in purpose. We partner with government agencies to solve complex challenges, improve public health, strengthen national security, and make government services more effective and efficient. Our team of over 500 professionals brings deep expertise and a shared commitment to delivering meaningful outcomes. Behind every solution is a group of experts who care deeply about impact-whether we're supporting data-driven decisions, modernizing systems or safeguarding critical programs.
Perform automated and complex medical record and claim reviews to make coverage determinations based on applicable Medicare coverage policies and payment rules, coding guidelines, National and Local Coverage Determinations, utilization/practice guidelines, and clinical review judgment. Provides professional assessment, planning, coordination, implementation, and reporting of complex data to support the Recovery Auditor Validation Contract (RVC).
Essential Functions
  • Perform accuracy review of automated and complex Medicare medical record and claims review in accordance with all State and Federal mandated regulations/guidelines.
  • Perform accuracy reviews as a Special Study requested by CMS.
  • Document findings for each claim in a clear and concise manner.
  • Compile a report explaining the claim reviews, including identified patterns, inappropriate determinations, as well as recommendations.
  • Reasonably determines appropriateness to consult a Subject Matter Expert (SME) for clarification.
  • Perform medical record reviews in response to RAC disputes/disagrees with the RVC review decisions.
  • Perform accuracy review of the New Issue Proposal for appropriate regulations, references, policies, and edit parameters. Compile a report of analysis and recommendations to submit to CMS.
  • Perform New Issue Quality Assurance Review for accuracy of all criteria and references.
  • Consistently meet or exceed productivity and accuracy standards of 95% minimum IRR established by the customer and/or the Company.
  • Report problems to the Medical Review Manager (MRM) and Project Manager (PM) regarding unique record or process issues.
  • Maintain security and confidentiality of medical records and Protected Health Information (PHI) and Personally Identifiable Information (PII).
  • Consistently meet attendance standards established by the Company and follows the telecommuting policy.
  • Interact appropriately with peers, co-workers, other Contractors, and the customer, when necessary. Contribute to building a positive team spirit.
  • On occasions may be asked by the MRM or PM to assist with development of training and/or resource materials.
  • May be asked to assist with precepting of new Medical Review Nurses (MRNs).
  • Perform other duties and projects as assigned.

Required Education and Experience
  • Registered Nurse, with a current unobstructed license to practice nursing in the United States. Graduate of a Board approved Registered Nursing program.
  • A Bachelor's Degree in Nursing (BSN) or other related field is preferred.
  • Certification in coding highly preferred.
  • A minimum of three (3) years clinical experience in an acute care hospital, skilled nursing facility, and/or an office/clinic-based medical practice.
  • A minimum of three (3) or more years' experience in medical/utilization medical record review particularly with Medicare and/or Medicaid.
  • Proficiency in research, interpretation, and application of Medicare, Medicaid, and local healthcare regulations and policies.
  • Must be proficient in Microsoft Office Suite such as Outlook, Excel and Word.

Skills & Abilities
  • Ability to work independently and maintain an elevated level of concentration.
  • Capable of consistency, speed, and accuracy of task.
  • Ability to read, analyze, and interpret physician documentation.
  • One year or more of utilizing InterQual and /or Milliman guidelines against inpatient services experience is preferred.
  • Ability to communicate clearly and professionally with all levels of the organization, both written and verbal.
  • Ability to work well in a remote team environment, to collaborate with others, and interface with team members internal and external to the organization.
  • Establishes and maintains effective professional relationships with internal and external stakeholders.
  • Must be able to adapt to organizational change.
  • Must be proficient in Microsoft Office Suite such as Outlook, Excel, and Word.
  • Flexibility and ability to plan, prioritize, and execute multiple tasks in a fast-paced environment.
  • Self-motivated, well-organized, and detail oriented.
  • Ability to maintain a high level of confidentiality and integrity

EEO Employer:
RELI Group is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.
HUBZone:
We encourage all candidates who live in a HUBZone to apply. You can check to see if your address is located in a HUBZone by accessing the SBA HUBZone Map.
The annual salary range for this position is $80,000 to $95,000. Actual compensation will depend on a range of factors, including but not limited to the individual's skills, experience, qualifications, certifications, location, other business and organizational needs, and applicable employment laws. The estimate displayed represents the typical salary range for this position and is just one component of the total compensation package for employees. RELI Group provides a variety of additional benefits to its employees. For additional details on the benefits that RELI Group offers click here

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