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Utilization Management Jobs in Baltimore, MD (NOW HIRING)

Ampcus

Spec, Utilization Management

Baltimore, MD · On-site

Spec, Utilization Management Job Location: Baltimore, MD Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective ...

Luminis Health

Utilization Management Nurse

Annapolis, MD · On-site

$34 - $55/hr

Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken ...

Luminis Health

Utilization Management Nurse

Annapolis, MD · On-site

$34 - $55/hr

Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken ...

Luminis Health

Utilization Management Nurse

Lanham, MD

$34 - $55/hr

Monitors and identifies patterns or trends in utilization management; monitors potential and actual denials and collaborates with care coordinator for any follow up necessary; documents actions taken ...

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All JobsUtilization Management JobsUtilization Management Jobs in Baltimore, MD

Utilization Management information

See Baltimore, MD salary details

$38.8K

$88.9K

$162K

How much do utilization management jobs pay per year?

As of Aug 9, 2026, the average yearly pay for utilization management in Baltimore, MD is $88,913.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,100.00 and $103,800.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in utilization management, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What is utilization management?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What are the typical daily responsibilities of a utilization management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

What are the most commonly searched types of Utilization Management jobs in Baltimore, MD? The most popular types of Utilization Management jobs in Baltimore, MD are:
What are popular job titles related to Utilization Management jobs in Baltimore, MD? For Utilization Management jobs in Baltimore, MD, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Baltimore, MD look for? The top searched job categories for Utilization Management jobs in Baltimore, MD are:
What cities near Baltimore, MD are hiring for Utilization Management jobs? Cities near Baltimore, MD with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Baltimore, MD as of August 2026, with employment types broken down into 93% Full Time, and 7% Contract. Highlights an 89% In-person, and 11% Remote job distribution, with an average salary of $88,913 per year, or $42.7 per hour.

Utilization Management Specialist

System One Holdings, LLC

Baltimore, MD • On-site

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 18 days ago

Job description

Utilization Management Specialist (UM / Utilization Review Nurse) - Remote
Location: 100% Remote (U.S.) - Maryland compact/eligibility required
Type: Contract (approx. 3 months; potential extension)
Schedule: Mon-Fri, 8:00am-5:00pm ET (1-hour lunch) - Flex after ramp-up start time between 7:00am-9:00am ET
Pay (W2): USD 51.00/H
Job overview
In this role, you'll use your clinical background and utilization management experience to review requests for care and determine medical necessity, appropriateness, and benefit coverage. You'll work fully remote and leverage MCG, medical policy, and regulatory guidelines while collaborating with Medical Directors and internal teams to support timely, accurate authorization decisions.
What you'll do
  • Perform prospective, concurrent, and retrospective utilization reviews (medical + behavioral health).
  • Make medical necessity / appropriateness determinations and support prior authorizations.
  • Use clinical criteria and policy resources daily (including MCG / Milliman Care Guidelines).
  • Review clinical documentation, benefits, and mandates to ensure services align with coverage and guidelines.
  • Research diagnoses/treatments and high-cost services; summarize findings and escalate complex cases to Medical Directors as needed.
  • Collaborate with internal partners and providers to support benefit application and appropriate levels/settings of care.
  • Maintain accurate documentation and protect PHI while managing a busy caseload.

Required qualifications
  • Active RN or LPN license (RN preferred) - Maryland compact/eligibility required
  • 5+ years clinical nursing experience
  • 2+ years care management / utilization management experience
  • MCG experience (required)
  • Experience supporting Commercial/FEP/Medicare lines of business and applying medical policy/regulatory standards
  • Strong critical thinking, written communication, and ability to work independently in a remote setting
  • Comfortable with web-based tools + Microsoft Office (Word/Excel/PowerPoint)
  • Guiding Care and FACETS (required)

Nice to have
  • Critical Care or ER clinical background
  • Experience with LCD/NCD, Medicare guidelines, ASAM, or other authorization criteria sets

System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.
System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.
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