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Utilization Manager Jobs in Frederick, MD (NOW HIRING)

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 ...

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 ...

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 ...

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All JobsUtilization JobsUtilization Manager JobsUtilization Manager Jobs in Frederick, MD

Utilization Manager information

See Frederick, MD salary details

$38.8K

$90.5K

$166.5K

How much do utilization manager jobs pay per year?

As of Jul 29, 2026, the average yearly pay for utilization manager in Frederick, MD is $90,490.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,200.00 and $108,900.00 per year, depending on experience, location, and employer.

What does a utilization manager do?

A utilization manager oversees the allocation and efficient use of resources, such as staff and equipment, to meet organizational goals. They analyze data, monitor utilization rates, and ensure compliance with policies, often using tools like spreadsheets or specialized software. This role requires strong organizational and communication skills to optimize productivity and control costs.

What jobs pay 4000 a week without a degree?

Utilization Managers typically require a relevant background in healthcare, logistics, or operations, and their salaries usually do not reach $4,000 weekly without specialized experience or certifications. High-paying roles that can reach this level without a degree often include sales, real estate, or skilled trades like certain construction or technical jobs, which rely more on experience and skills than formal education.

What are the key skills and qualifications needed to thrive as a Utilization Manager, and why are they important?

To thrive as a Utilization Manager, you need a solid background in healthcare management, case review, and knowledge of insurance regulations, often supported by a degree in nursing, healthcare administration, or a related field. Familiarity with utilization management software, electronic health records (EHRs), and certification such as Certified Case Manager (CCM) are typically required. Strong analytical thinking, communication, and negotiation skills help Utilization Managers effectively coordinate care and collaborate with providers. These skills ensure appropriate resource use, regulatory compliance, and optimal patient outcomes within healthcare organizations.

What is the highest paying job in healthcare management?

The highest paying roles in healthcare management include Chief Executive Officers (CEOs) of hospitals and health systems, with salaries often exceeding $200,000 annually. Other high-paying positions include Chief Financial Officers (CFOs) and Chief Operating Officers (COOs), who oversee organizational strategy and operations, typically earning six-figure salaries. These roles require extensive experience, advanced degrees, and strong leadership skills.

What are some common challenges faced by Utilization Managers, and how can they be addressed?

Utilization Managers often face challenges such as balancing cost containment with patient care quality, navigating complex insurance policies, and managing high caseloads. To address these, effective communication with healthcare providers and payers is essential, as is staying current with regulatory requirements and best practices. Building strong relationships within interdisciplinary teams and leveraging data analytics tools can also help Utilization Managers make informed decisions and improve workflow efficiency.

What Is a Utilization Manager?

A utilization manager works in the insurance industry to analyze health care needs in medical cases and determine further patient care. In this career, your job duties include conducting interviews to determine what services you register for and cutting down on unnecessary costs. You may review medical records and compile documentation to improve care and report your findings. Skills in management, customer service, and health care services are vital in this career. Job experience in nursing is a benefit when applying for utilization manager positions. Additional qualifications include a bachelor’s degree and medical case management certificate.

What is the difference between Utilization Manager vs Utilization Coordinator?

AspectUtilization ManagerUtilization Coordinator
CertificationsOften requires healthcare or case management certificationsMay have similar certifications but less emphasis on management
Work EnvironmentTypically in healthcare organizations, overseeing utilization review processesSupports daily operations, assisting with case documentation and scheduling
Employer & Industry UsageCommon in healthcare, insurance, and managed care companiesFound in similar settings, often working under Utilization Managers

In summary, a Utilization Manager generally has broader responsibilities, overseeing utilization review and resource allocation, while a Utilization Coordinator focuses on supporting daily tasks and documentation. Both roles are integral in healthcare settings but differ in scope and level of responsibility.

Is being a MOA a good entry level job?

A Medical Office Assistant (MOA) role is often considered an entry-level position in healthcare, requiring basic administrative skills and knowledge of medical terminology. It provides experience in patient interaction, scheduling, and office management, which can serve as a stepping stone to more advanced healthcare roles. However, career advancement may require additional certifications or education.
More about Utilization Manager jobs
What are popular job titles related to Utilization Manager jobs in Frederick, MD? For Utilization Manager jobs in Frederick, MD, the most frequently searched job titles are:
What job categories do people searching Utilization Manager jobs in Frederick, MD look for? The top searched job categories for Utilization Manager jobs in Frederick, MD are:
What cities near Frederick, MD are hiring for Utilization Manager jobs? Cities near Frederick, MD with the most Utilization Manager job openings:
Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Frederick, MD as of July 2026, with employment types broken down into 89% Full Time, 10% Part Time, and 1% Contract. Highlights an 93% Physical, 3% Hybrid, and 4% Remote job distribution, with an average salary of $90,490 per year, or $43.5 per hour.

Utilization Review Nurse RN - PRN

LifeBridge Health

Westminster, MD • On-site

Other

PTO

Posted 29 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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