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Utilization Review Manager Jobs in Baltimore, MD

Luminis Health

Utilization Management Nurse

Lanham, MD · On-site

$34 - $55/hr

Reviews the medical record by applying utilization review criteria, to assess clinical, financial ... Monitors and identifies patterns or trends in utilization management; monitors potential and actual ...

Luminis Health

Utilization Management Nurse

Annapolis, MD · On-site

$34 - $55/hr

Reviews the medical record by applying utilization review criteria, to assess clinical, financial ... Monitors and identifies patterns or trends in utilization management; monitors potential and actual ...

Luminis Health

Utilization Management Nurse

Annapolis, MD · On-site

$34 - $55/hr

Reviews the medical record by applying utilization review criteria, to assess clinical, financial ... Monitors and identifies patterns or trends in utilization management; monitors potential and actual ...

ICONMA

Spec, Utilization Management

Baltimore, MD · On-site

Spec, Utilization Management Our client, a Health Insurance company, is looking for a Spec ... Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist will ...

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Utilization Review Manager information

See Baltimore, MD salary details

$38.8K

$90.4K

$166.4K

How much do utilization review manager jobs pay per year?

As of Sep 3, 2026, the average yearly pay for utilization review manager in Baltimore, MD is $90,432.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,100.00 and $108,800.00 per year, depending on experience, location, and employer.

What does a utilization review manager do?

A Utilization Review Manager oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that patient care adheres to established guidelines and that healthcare resources are used effectively. Their duties typically include leading a team of reviewers, collaborating with healthcare providers, ensuring compliance with regulations, and making recommendations on care authorization. The goal is to balance quality patient care with cost-effective resource management.

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

To thrive as a Utilization Review Manager, you need a solid background in healthcare management, clinical knowledge (often as an RN or healthcare professional), and experience with utilization review processes. Familiarity with case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Utilization Review (CPUR) are often expected. Strong analytical thinking, attention to detail, leadership, and effective communication are crucial soft skills for success in this role. These skills ensure appropriate resource use, regulatory compliance, and coordinated patient care, which are vital for both healthcare quality and operational efficiency.

What are some common challenges faced by utilization review managers in balancing patient care and cost efficiency?

Utilization Review Managers often encounter the challenge of ensuring patients receive appropriate care while also adhering to insurance and regulatory guidelines that emphasize cost efficiency. This requires strong analytical skills to assess clinical information and make fair determinations, often under tight deadlines and with incomplete data. The role also involves frequent communication with physicians, payers, and case managers to resolve disagreements and clarify criteria, making negotiation and diplomacy essential. Staying updated on changing healthcare regulations and payer requirements can add to the complexity, but it also provides opportunities for professional growth and leadership within healthcare administration.

What is the difference between Utilization Review Manager vs Utilization Review Coordinator?

AspectUtilization Review ManagerUtilization Review Coordinator
CertificationsTypically requires certifications like CCM or ACUMay require similar certifications but often less advanced
Work EnvironmentSupervises review teams, manages processes in healthcare or insurance settingsPerforms case reviews, supports the review process under supervision
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare providers, third-party administrators

The Utilization Review Manager oversees review teams and manages utilization review processes, focusing on policy compliance and efficiency. The Utilization Review Coordinator supports the review process by conducting case assessments and assisting managers. While both roles require similar certifications and work in related environments, the manager holds a supervisory position with broader responsibilities.

How much does a utilization review manager make?

A utilization review manager typically earns between $70,000 and $110,000 annually, depending on experience, location, and the size of the organization. They often require knowledge of healthcare policies, insurance processes, and may hold certifications such as URAC or CCM.

Is utilization review manager a stressful job?

Utilization review managers often work in a fast-paced healthcare environment, which can be stressful due to the need to meet strict deadlines, ensure accurate assessments, and handle complex cases. The role requires strong organizational skills and attention to detail, and some individuals may find the responsibility and workload challenging, especially during high-volume periods.

What are the most commonly searched types of Utilization Review jobs in Baltimore, MD?

The most popular types of Utilization Review jobs in Baltimore, MD are:

What are popular job titles related to Utilization Review Manager jobs in Baltimore, MD?

For Utilization Review Manager jobs in Baltimore, MD, the most frequently searched job titles are:

What job categories do people searching Utilization Review Manager jobs in Baltimore, MD look for?

The top searched job categories for Utilization Review Manager jobs in Baltimore, MD are:

What cities near Baltimore, MD are hiring for Utilization Review Manager jobs?

Cities near Baltimore, MD with the most Utilization Review Manager job openings:

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Baltimore, MD as of August 2026, with employment types broken down into 86% Full Time, 12% Part Time, and 2% Contract. Highlights an 84% Physical, 2% Hybrid, and 14% Remote job distribution, with an average salary of $90,432 per year, or $43.5 per hour.

Utilization Management Coordinator

System One

Baltimore, MD • Remote

Contractor

Medical, Dental, Vision, Life, Retirement

Re-posted 27 days ago

Job description

UTILIZATION MANAGEMENT COORDINATOR

Location: Remote — client site in Baltimore, MD (21224) Type: Contract (3 months to start; expected extension possible) Schedule: 40 hours/week — must include a weekend day Pay (W2): USD 24.70/H

JOB OVERVIEW

In this role, you’ll support Utilization Management (UM) clinical teams by handling non-clinical administrative work tied to pre-service authorization, utilization review support, care coordination workflows, and quality-of-care processes. You’ll help manage authorization intake, documentation, and provider/member support—while working in a fast-paced environment where schedule flexibility (including weekends) is required.

WHAT YOU’LL DO

  • Provide member/provider administrative support such as benefit verification, authorization creation/management, claims inquiries, and case documentation.

  • Review incoming authorization requests for initial determination and/or triage items for clinical review and resolution.

  • Support day-to-day coordination for the department, including answering/responding to phone calls, taking messages, and responding to basic inquiries.

  • Research information and assist with issue resolution and operational problem-solving.

  • Assist with reporting, data tracking, and organizing/disseminating information (including Continuity of Care processes and tracking Peer-to-Peer reviews).

REQUIRED QUALIFICATIONS

  • High School Diploma (or equivalent)

  • 3+ years of experience in healthcare claims/service areas and/or healthcare office/administrative support

  • Ability to work effectively within a multidisciplinary team (internal and external partners)

  • Strong communication, organization, and customer service skills

  • Strong attention to detail with sound judgment and decision-making

  • Comfortable with web-based tools and Microsoft Office (Word, Excel, PowerPoint)

NICE TO HAVE

  • Knowledge of CPT and ICD-10 coding / medical terminology used in managed care

  • Experience in a managed care environment (health plan / UM support)

  • Phone-heavy/customer support experience

  • Experience with Medicaid/Medicare (government programs)

  • Exposure to tools such as Facets, Guiding Care, and/or NICE CXone

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.

#M-M2 #LI-

Ref: #851-Rockville-S1

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About System One

Sourced by ZipRecruiter

System One helps employers get work done more efficiently and economically without compromising quality. Over our 35+ year history, we've helped connect thousands of talented people with innovative companies. The excitement of a perfect fit motivates us every single day.

Industry

Business consulting services and recruiting and staffing services

Company size

5,001 - 10,000 Employees

Headquarters location

Pittsburgh, PA, US

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