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Utilization Case Manager Jobs in Baltimore, MD (NOW HIRING)

Corvel

Telephonic Case Manager I

Nottingham, MD · Remote

$63K - $95K/yr

The Case Manager communicates directly with treating physicians to evaluate and recommend ... Strong cost containment background, such as utilization review or managed care helpful

MedStar Health

RN Inpatient Case Manager

Baltimore, MD · On-site

$89K - $162K/yr

Monitors the care and services delivered to selected patient populations during the acute hospital stay promotes effective case management and utilization of resources and works to achieve optimal ...

Corvel

Telephonic Case Manager I

Nottingham, MD · Remote

$63K - $95K/yr

The Case Manager communicates directly with treating physicians to evaluate and recommend ... Strong cost containment background, such as utilization review or managed care helpful

MedStar Health

RN Inpatient Case Manager

Rosedale, MD · On-site

$89K - $162K/yr

Monitors the care and services delivered to selected patient populations during the acute hospital stay promotes effective case management and utilization of resources and works to achieve optimal ...

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All JobsUtilization Case JobsUtilization Case Manager JobsUtilization Case Manager Jobs in Baltimore, MD

Utilization Case Manager information

See Baltimore, MD salary details

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$59

How much do utilization case manager jobs pay per hour?

As of Aug 12, 2026, the average hourly pay for utilization case manager in Baltimore, MD is $36.25, according to ZipRecruiter salary data. Most workers in this role earn between $29.38 and $38.22 per hour, depending on experience, location, and employer.

What is a utilization case manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

How does a utilization case manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

What degree do I need for utilization review?

Utilization case managers typically need at least a bachelor's degree in healthcare, nursing, social work, or a related field. Some positions may require a master's degree or professional certification, such as a Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ), to advance in the role or handle complex cases.

What are the key skills and qualifications needed to thrive as a utilization case manager?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

What is the difference between Utilization Case Manager vs Utilization Review Nurse?

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What are popular job titles related to Utilization Case Manager jobs in Baltimore, MD? For Utilization Case Manager jobs in Baltimore, MD, the most frequently searched job titles are:
What job categories do people searching Utilization Case Manager jobs in Baltimore, MD look for? The top searched job categories for Utilization Case Manager jobs in Baltimore, MD are:
What cities near Baltimore, MD are hiring for Utilization Case Manager jobs? Cities near Baltimore, MD with the most Utilization Case Manager job openings:
Utilization Case Manager jobs near you

Manager for Case Management- Bayview Location

Johns Hopkins Medical Management Corporation

Baltimore, MD • On-site

$95/hr

Temporary

Re-posted 7 days ago

Job description

Overview

Johns Hopkins Intrastaff is the internal staffing agency for the Johns Hopkins Health System and partner hospitals, providing temporary support to a variety of the Johns Hopkins locations. Our employees are the strength of our service.  Intrastaff is unique because it's one of the very few agencies where a person has the benefit of being a temporary employee and also feels like a member of a large organization. Working at Hopkins means joining a culturally diverse team that includes some of the best nurses, physicians and allied health professionals in the world. Directly or indirectly, you'll have exposure to cutting-edge technology and groundbreaking medical research.

  • Summary

    • Responsible for the coordination, supervision, and administrative oversight to the case management team. Functions as an expert clinical practitioner, resource, advisor and leader for the members of the case management team. Supervises and monitors professional and support staff and ensures that effective care coordination and case management practices are consistent with Medical Center policies, and applicable regulations and guidelines. Monitors quality of documentation and assessments with the patient/family by regular auditing.

    12 week contract- most likely an extension 

    M-F 8:30-5pm

    No weekends

    Payrate- $95 per hr

    Responsibilities

    Principal Duties and Responsibilities

  • Ensures adequate staffing coverage of all areas of responsibility by monitoring staffing needs, preparing schedules and approving leave requests, and arranging for coverage when staff are absent. Coordinates with the manager utilization management as needed.
  • Ensures that policies and procedures are kept current and staff is educated and monitored to be in compliance.
  • May coordinate interdisciplinary care for a select caseload of patients from pre-admission through post discharge and taking into consideration

    • the age and development needs of the patient.

  • Coaches the case managers by review and ongoing case discussion to develop the optimal safe transition plan taking into account patient and family preferences.
  • Evaluates readmissions with the Collaborative Practice Team to identify ways to improve the transition plan with the goal to reduce readmission.
  • Attends interdisciplinary rounds routinely on units to identify barriers in transition planning and assist the case manager in addressing those barriers. Ensures that the interdisciplinary rounds follow standard work processes and collaborative communication with the team.
  • Develops relationships with the medical staff to increase collaboration and ensure open and reliable communication around initiatives and patient care issues.
  • Acts as a preceptor for case managers in the onboarding process or oversees the orientation if the preceptor role is delegated.
  • Incorporates the principles of reimbursement and managed care strategies into case management services.
  • May participate on relevant administrative and clinical committees.
  • Ensures that staff are oriented to various areas of assignment and maintain the necessary levels of training and continuing education.
  • Works with clinical and administrative staff to identify undesirable trends in clinical service delivery and patient outcomes and participates in efforts to improve performance in these areas.
  • Responsible for personnel management activities to achieve quality services and positive employee relations including performance reviews, counseling and discipline and assisting supporting staff in resolving complex or difficult issues.
  • Monitor the quality of services rendered by staff. Assures that monitoring activities are completed according to established policies.  Evaluates the results of monitoring activities and implements corrective actions for deviations from standards.
  • Responsible for effective fiscal management to ensure efficient utilization of financial and material resources. Participates in the preparation of the annual budget, monitors expenditures, and completes appropriate reports in a timely manner.
  • Participates in leadership activities and special projects pertinent to area of management and as assigned by the Director.
  • Responsible for review and authorizations of charity care.

    • .

    Qualifications

    Required Knowledge, Skills and Abilities

    Work requires the level of knowledge of theories, principles and concepts typically acquired through the completion of a Bachelor's degree in nursing or a closely related field. Master's degree is preferred. 

    Current MD licensure as a Registered Nurse required. Annual Certification in CPR is required. Certification required within 2 years of the position, ACM or CCM.

    Requires 5 years of experience in case management.

    At least one year of team leader or other leadership experience.

    Knowledge of insurance benefit structures, Medicare Conditions of Participation and regulations.

    Knowledge of utilization management and quality improvement processes.

    Knowledge of outpatient services and settings available.

    Work requires the analytical skills necessary to resolve problems requiring a professional level of knowledge in a specific discipline/field and/or improve, enhance, or upgrade complex clinical, financial, data processing, marketing, or human resources systems and programs.

    Work requires the communication skills necessary to effectively manage the employees within assigned area and to persuade and negotiate with peer-level managers on issues and programs that impact the department. Work requires effectively dealing with conflicting views or issues and mediating fair and workable solutions.

    Must complete the Training Checklist for Managers and Supervisors (described in the Training Catalog under Management Development Curriculum) within twelve months of employment/promotion date.

    Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

    Employment Type: TEMPORARY

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