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Utilization Management Jobs in Frederick, MD (NOW HIRING)

Inova

Registered Nurse (RN) Case Manager 1

Leesburg, VA · On-site

Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities. * Discusses payer criteria and ...

Inova

Registered Nurse (RN) Case Manager 1

Leesburg, VA · On-site

$86K - $140K/yr

Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities. * Discusses payer criteria and ...

Maryland Physicians Care

Manager, SDoH

Frederick, MD · On-site

$88K - $97K/yr

Drives the advancement of integrated social care models by partnering across care management, utilization management, community engagement, prevention and wellness, HEDIS, and community-based ...

UMR

Specialty Pharmacist

Hagerstown, MD · On-site

$91K - $163K/yr

Oversee prior authorizations and utilization management, ensuring compliance with payer and program requirements * Monitor effectiveness and safety of therapy, including lab values, adherence metrics ...

MSD

Data Management Specialist

Gaithersburg, MD · On-site

$59K - $87K/yr

Formulate and implement policies, procedures, and standards relating to database management, and monitor transaction activity and utilization. • Provide training and guidance to users on effective ...

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Utilization Management information

See Frederick, MD salary details

$38.8K

$89K

$162.1K

How much do utilization management jobs pay per year?

As of Jul 28, 2026, the average yearly pay for utilization management in Frederick, MD is $88,970.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,100.00 and $103,900.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Utilization Management position, 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 a Utilization Management job?

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 Frederick, MD? The most popular types of Utilization Management jobs in Frederick, MD are:
What are popular job titles related to Utilization Management jobs in Frederick, MD? For Utilization Management jobs in Frederick, MD, the most frequently searched job titles are:
What job categories do people searching Utilization Management jobs in Frederick, MD look for? The top searched job categories for Utilization Management jobs in Frederick, MD are:
What cities near Frederick, MD are hiring for Utilization Management jobs? Cities near Frederick, MD with the most Utilization Management job openings:
Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Frederick, MD as of July 2026, with employment types broken down into 1% As Needed, 86% Full Time, 10% Part Time, 1% Temporary, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $88,970 per year, or $42.8 per hour.
Utilization Review Nurse RN - PRN

Utilization Review Nurse RN - PRN

LifeBridge Health

Westminster, MD

Other

PTO

Posted 27 days ago

LifeBridge Health rating

6.2

Company rating: 6.2 out of 10

Based on 79 frontline employees who took The Breakroom Quiz

701st of 890 rated healthcare providers

Job description

Position Summary

The Utilization Review Nurse is responsible for conducting initial, concurrent, and retrospective medical record reviews to evaluate the appropriateness of patient care, resource utilization, and reimbursement. This role collaborates closely with Care Management, physicians, patient access, financial counselors, and third-party payers to ensure accurate clinical documentation, timely authorization, and effective coordination of care while minimizing avoidable delays and payment denials.

Key Responsibilities
  • Perform initial, concurrent, and retrospective utilization reviews using established clinical criteria to evaluate medical necessity, level of care, and resource utilization.
  • Review medical records for clinical, financial, and utilization management information and accurately document findings in the designated utilization management software.
  • Communicate with third-party payers to obtain certifications, authorizations, and continued stay approvals by providing relevant clinical information.
  • Monitor utilization trends, identify potential or actual denials, and implement interventions to reduce avoidable delays and reimbursement issues.
  • Collaborate with Care Managers, Social Workers, physicians, financial counselors, and patient access staff to coordinate patient care and support appropriate discharge planning.
  • Assist Care Managers in communicating denied hospital days and issuing required Medicare notices, including the Hospital-Issued Notice of Noncoverage (HINN) and Detailed Notice of Discharge, to patients and families when appropriate.
  • Coordinate with Care Management to promote efficient patient throughput, optimize length of stay, and improve patient outcomes.
  • Escalate cases that do not meet medical necessity criteria to the Physician Advisor for review and recommendations.
  • Partner with the Physician Advisor and interdisciplinary team to facilitate expedited appeals and resolve payer-related issues.
  • Maintain compliance with organizational policies, payer requirements, regulatory standards, and documentation guidelines.
  • Identify opportunities for process improvement within utilization management and contribute to quality initiatives.
  • Perform other duties as assigned.
QualificationsRequired
  • Active Registered Nurse (RN) license in good standing.
  • Knowledge of utilization review, medical necessity criteria, reimbursement processes, and payer regulations.
  • Strong clinical assessment and critical thinking skills.
  • Excellent communication, documentation, and organizational skills.
  • Ability to work collaboratively with interdisciplinary teams and external payer representatives.
  • Proficiency with electronic health records (EHR) and utilization management software.
  • Previous experience in Utilization Management, Case Management, or Care Coordination.
  • Experience using InterQual®, MCG®, or other evidence-based utilization review criteria.
  • Certification in Case Management (CCM), Utilization Review (CPUR), or a related specialty preferred.
Benefits
  • Competitive PRN rate
  • Flexible Schedule
  • Paid time off and holidays
  • Collaborative and supportive work environment
 

What LifeBridge Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About LifeBridge Health

Sourced by ZipRecruiter

LifeBridge Health is a $2B, 13,000 team member healthcare system that Cares Bravely for over 1 million patients annually throughout Maryland. We are comprised of 5 main healthcare centers: Sinai Hospital, Northwest Hospital, Carroll Hospital, Levindale Hebrew Geriatric Center and Hospital, and Grace Medical Center as well as several specialty and primary care locations throughout Baltimore.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Baltimore, MD, US

Year founded

1988

Social media

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