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Remote Weekend Utilization Review Jobs in Maryland

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 ...

New

CareFirst

Care Manager (Remote)

Baltimore, MD · Remote

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 · 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 ...

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 ...

Ourhrconnect

This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:

New

Ourhrconnect

This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:

Ourhrconnect

This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:

New

Ourhrconnect

This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or ... Knowledge of medical and utilization review techniques. * Required Licenses and Certifications:

CareFirst

Clinical Navigator (Remote)

Baltimore, MD · Remote

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

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 ...

New

CSAA

Lead operational governance activities across assigned Clubs, including creative review oversight ... Track and monitor Club marketing funding utilization to ensure compliance with Producer Agreements

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

Remote Weekend Utilization Review information

What is the difference between Remote Weekend Utilization Review vs Remote Weekday Utilization Review?

AspectRemote Weekend Utilization ReviewRemote Weekday Utilization Review
CredentialsTypically requires a healthcare professional license and utilization review certificationSame as weekend role, healthcare license and utilization review certification
Work EnvironmentRemote, weekend hours, often part-time or flexibleRemote, weekday hours, standard business hours
Employer & IndustryHealth insurance companies, third-party administratorsSame as weekend role, health insurance industry
Work SchedulePrimarily weekends, possibly eveningsWeekdays, regular business hours

Remote Weekend Utilization Review and Remote Weekday Utilization Review roles are similar in credentials and industry but differ mainly in work schedule. Weekend roles focus on reviewing cases during weekends, offering flexibility, while weekday roles follow standard business hours. Both positions require healthcare licensing and utilization review certification, serving health insurance companies and third-party administrators.

What are the most commonly searched types of Weekend Utilization Review jobs in Maryland? The most popular types of Weekend Utilization Review jobs in Maryland are:
What are popular job titles related to Remote Weekend Utilization Review jobs in Maryland? For Remote Weekend Utilization Review jobs in Maryland, the most frequently searched job titles are:
What job categories do people searching Remote Weekend Utilization Review jobs in Maryland look for? The top searched job categories for Remote Weekend Utilization Review jobs in Maryland are:
What cities in Maryland are hiring for Remote Weekend Utilization Review jobs? Cities in Maryland with the most Remote Weekend Utilization Review job openings:
Remote Weekend Utilization Review jobs near you
Infographic showing various Remote Weekend Utilization Review job openings in Maryland as of August 2026, with employment types broken down into 78% Full Time, 11% Part Time, and 11% Contract. Highlights an 100% Remote job distribution.

Clinical Guide Part A: Utilization Management Nurse

Devoted Health

Nottingham, MD • On-site, Remote

$85K - $95K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 27 days ago

Devoted Health rating

9.0

Company rating: 9.0 out of 10

Based on 14 frontline employees who took The Breakroom Quiz

36th of 301 rated insurance

Job description

Job Description
Schedule:
The weekly schedule choice is either Monday - Friday 10am-7pm EST OR Tuesday - Saturday 9am-6pm EST
A bit about this role:
The Clinical Guide Part A will be part of the Utilization Management team, responsible for inpatient, behavioral health, and/or post-acute authorization review in alignment with CMS and Medicare Advantage regulations.
Reviews medical records to evaluate the medical necessity and appropriateness of requested inpatient and/or post-acute services in accordance with established clinical criteria and CMS guidelines.
Your Responsibilities and Impact will include:
  • Review Medical Records: Conduct prospective (pre-service), concurrent, and retrospective utilization review to evaluate medical necessity, appropriate level of care (Inpatient vs. Observation), and post-acute services in accordance with established clinical criteria and CMS guidelines.
  • Evaluate Treatment Plans: Assess the appropriateness, timing, and setting of requested services, ensuring alignment with medical necessity criteria and Medicare Advantage requirements. Recommend alternative levels of care when clinically appropriate.
  • Inpatient & Behavioral Health Review: Perform initial, concurrent, and discharge reviews for inpatient and behavioral health admissions. Ensure admission status accuracy and regulatory compliance with CMS timeliness (TAT) standards.
  • Post-Acute Review: Conduct initial authorization and concurrent review for post-acute services (SNF, LTACH, ARU, Home Health), evaluating ongoing medical necessity and appropriate length of stay. Issue NOMNC when coverage criteria are no longer met.
  • Medical Director Collaboration: Refer cases that do not meet criteria to the Medical Director for secondary review and final determination. Prepare clinical summaries and coordinate peer-to-peer (P2P) discussions. Manage authorization reopen requests as appropriate.
  • Resource Stewardship: Monitor utilization of inpatient and post-acute services to promote appropriate resource use while maintaining high-quality, member-centered care.
  • Regulatory & Documentation Compliance: Maintain accurate, defensible documentation of all determinations. Ensure adherence to CMS regulations, Medicare Advantage requirements, and internal compliance standards.

Required skills and experience:
  • Unrestricted RN license with a minimum of 4 years of clinical experience.
  • Minimum 3 years of Utilization Management or Inpatient UR experience within a health plan or hospital setting.
  • Strong knowledge of CMS regulations and Medicare Advantage requirements.
  • Experience preparing cases for Medical Director review
  • Able to work in a fast paced environment that is constantly evolving.

Desired skills and experience:
  • Experience with AI/LLM
  • Certified in InterQual

#LI-Remote
#LI-DS1
Salary Range: $85,000-$95,000 / year
The pay range listed for this position is the range the organization reasonably and in good faith expects to pay for this position at the time of the posting. Once the interview process begins, your talent partner will provide additional information on the compensation for the role, along with additional information on our total rewards package. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Our Total Rewards package includes:
  • Employer sponsored health, dental and vision plan with low or no premium
  • Generous paid time off
  • $100 monthly mobile or internet stipend
  • Stock options for all employees
  • Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles
  • Parental leave program
  • 401K program
  • And more....

*Our total rewards package is for full time employees only. Intern and Contract positions are not eligible.
Founded in 2017, Devoted Health is on a mission to dramatically improve the health and well-being of older Americans by caring for everyone like they are family, and that includes our employees. Our robust and seamlessly integrated care platform merges advanced data and AI access with world-class clinical and service experiences to create a member experience that is unlike the industry norm. To continue building upon our mission, we want to bring together those who share our values, embrace change and advancement, and are enthusiastic about where we're going - all the while bringing their own unique qualities, experiences, and expertise, in hopes of further changing the healthcare experience.
Devoted is an equal opportunity employer. We are committed to a safe and supportive work environment in which all employees have the opportunity to participate and contribute to the success of the business. We value diversity and collaboration. Individuals are respected for their skills, experience, and unique perspectives. This commitment is embodied in Devoted's Code of Conduct, our company values and the way we do business.
As an Equal Opportunity Employer, the Company does not discriminate on the basis of race, color, religion, sex, pregnancy status, marital status, national origin, disability, age, sexual orientation, veteran status, genetic information, gender identity, gender expression, or any other factor prohibited by law. Our management team is dedicated to this policy with respect to recruitment, hiring, placement, promotion, transfer, training, compensation, benefits, employee activities and general treatment during employment.

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