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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

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 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 ...

Global Alliant Inc

Clinical Analyst

Baltimore, MD · Remote

Remote Job Duration: Contract / FTE Client: Federal Criteria- Need US citizenship because of ... Utilization Management / Utilization Review / Prior Authorization * Clinical or healthcare ...

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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 Sep 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 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 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 August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 4% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $90,917 per year, or $43.7 per hour.

Utilization Management Specialist - Remote / Telecommute

CYNET SYSTEMS

Baltimore, MD • Remote

$46 - $51/hr

Contractor

Re-posted 24 days ago

Job description

Job Overview:

Pay Range: $46.76hr - $51.76hr

Requirement/Must Have:

  • Master’s Degree or higher in Behavior Analysis, Psychology, Education, or a related field.
  • Board Certified Behavior Analyst (BCBA) – Required.
  • Active state licensure as a Behavior Analyst (if applicable in practicing state) – Required.
  • Minimum 3–5 years of clinical ABA experience, including development and supervision of ABA treatment programs.

Responsibilities:

  • Reviews ABA treatment requests (initial, concurrent, and retrospective) to determine medical necessity, clinical appropriateness, and benefit coverage.
  • Applies behavior analytic principles and clinical expertise to evaluate treatment plans, goals, supervision models, and service intensity.
  • Determines medical necessity and appropriateness by referencing regulatory mandates, contracts, benefit information, Milliman Care Guidelines, Apollo Guidelines, ASAM, Medicare Guidelines, Federal Employee Program and Policy Guidelines, Medical Policy, and other accepted medical/pharmaceutical references.
  • Follows NCQA Standards and departmental SOPS to manage member assignments.
  • Conducts research and analysis of behavioral health conditions, ABA treatment methodologies, and emerging practices within the field of behavior analysis.
  • Collaborates with medical directors, sales and marketing, contracting, provider and member services to determine appropriate benefit application.
  • Coordinates non-par provider/facility case rate negotiations between Provider Contracting, providers, and facilities.
  • Makes appropriate referrals and contacts as appropriate.
  • Offers assistance to members and providers for alternative settings for care.
  • Provides guidance to providers and internal teams regarding ABA best practices, documentation standards, and authorization requirements.
  • Develops and presents educational materials on ABA topics, treatment trends, and case learnings to internal stakeholders.

Nice to Have:

  • Prior experience in utilization management, care management, or payer-side review of ABA services.
  • Working knowledge of managed care and health delivery systems.
  • Thorough knowledge of clinical guidelines, medical policies, and accreditation and regulatory standards.
  • Working knowledge of IT and Medical Management systems, familiarity with web-based software application environment.

Skills:

  • Effective written and interpersonal communication skills to engage with members, healthcare professionals, and internal colleagues.
  • Strong assessment skills with the ability to make rapid connections with members telephonically.
  • Ability to work effectively with large amounts of confidential member data and PHI.
  • Ability to prioritize workload during heavy workload periods.
  • Ability to multitask, prioritize, and maintain a dynamic personal organization system that allows for flexibility.
  • Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel, and PowerPoint.
  • Excellent analytical and problem-solving skills to judge appropriateness of member services and treatments on a case-by-case basis.

Founded in 2010 and headquartered in the Washington, DC metro area, Cynet Systems Inc. is a leading staffing and recruiting powerhouse. Proudly recognized as a nationally and locally certified diversity firm, Cynet delivers agile, scalable talent solutions across industries. With an active footprint in all 50 U.S. states and Canada, we support thousands of consultants through our expansive, high-performing recruitment engine operating across North America and Asia—ensuring speed, quality, and consistency in every hire.
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About Cynet Systems

Sourced by ZipRecruiter

Cynet Systems Inc is a staffing and recruiting corporation nestled in Ashburn, VA, USA. Established in 2010, the company operates within the Information Technology and Services sector, specializing in providing effective workforce solutions to different business needs, including IT consulting, direct hire, and contract staffing services. Through the years, Cynet Systems has built an impressive portfolio, going beyond borders and expanding its operations internationally in Canada and India. Rooted in its core values of teamwork, leadership, and commitment, Cynet Systems helps businesses unlock their full potential by providing versatile and competent professionals that perfectly align with their needs. Fueled by their unwavering mission to deliver top-tier talent to businesses worldwide, Cynet Systems garnered various recognitions including SIA's fastest-growing staffing firms and Best Place to Work in Virginia for 2019.

Industry

It services

Company size

501 - 1,000 Employees

Headquarters location

Sterling, VA, US

Year founded

2010

Social media

Twitter

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