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Remote Utilization Review Jobs in Maryland (NOW HIRING)

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 ...

CareFirst

Care Manager (Remote)

Baltimore, MD · Remote

  • Medical

  • Retirement

While this position is remote, the incumbent will be expected to come into a CareFirst location ... Utilization Review, Disease Management or other direct patient care experience. Preferred ...

RELI Group Inc.

Medical Review Nurse III

Baltimore, MD · On-site +1

$80K - $95K/yr

A minimum of three (3) or more years' experience in medical/utilization medical record review ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...

RELI GROUP INC

Medical Review Nurse III

Baltimore, MD · Remote

A minimum of three (3) or more years' experience in medical/utilization medical record review ... Ability to work well in a remote team environment, to collaborate with others, and interface with ...

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

  • Medical

  • Retirement

... Utilization Review. Preferred Qualifications: * Knowledge and experience with MCG * Experience working with Commercial and Federal Employee Program employee group member and Medicare/Medicaid ...

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

  • Medical

  • Retirement

Washington, DC Experience: 5 years clinically related experience working in an acute care setting, and/or Utilization Review. Preferred Qualifications: * Knowledge and experience with MCG

TEKsystems

Insurance Verification Coordinator

Annapolis, MD · Remote

$17.50 - $26/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Remote (Must reside in Maryland, Pennsylvania, Washington D.C., West Virginia, Virginia, Tennessee ... utilization review, and clinical departments to secure required approvals. • Notify patients and ...

CareFirst

Clinical Appeals Nurse (Remote)

Baltimore, MD · Remote

  • Retirement

Three (3) years Medical Review, Utilization Management, Nurse Auditor/Revenue Integrity, and/or Appeal and Grievance review at CareFirst BlueCross BlueShield, or similar Managed Care organization or ...

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

Remote Utilization Review information

See Maryland salary details

$20

$41

$66

How much do remote utilization review jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for remote utilization review 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 are the key skills and qualifications needed to thrive in remote utilization review?

To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.

What does a remote utilization review do?

A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.

What is a remote utilization review?

A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.

What are the most commonly searched types of Utilization Review jobs in Maryland? The most popular types of Utilization Review jobs in Maryland are:
What are popular job titles related to Remote Utilization Review jobs in Maryland? For Remote Utilization Review jobs in Maryland, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review jobs in Maryland look for? The top searched job categories for Remote Utilization Review jobs in Maryland are:
What cities in Maryland are hiring for Remote Utilization Review jobs? Cities in Maryland with the most Remote Utilization Review job openings:
Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Maryland as of August 2026, with employment types broken down into 85% Full Time, and 15% Part Time. Highlights an 25% In-person, and 75% 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 12 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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