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Utilization Review Manager Jobs in Silver Spring, MD

MedStar Health

RN Utilization Review (PRN)

Washington, DC · On-site

$89K - $162K/yr

Minimum of 2 years experience in case management utilization review experience required! Licenses and Certifications * RN - Registered Nurse - State Licensure and/or Compact State Licensure in the ...

MedStar Health

RN Utilization Mgmt

Washington, DC · On-site

$89K - $162K/yr

About the Job General Summary of Position The RN Utilization Manager will have 1-2 years of Utilization review- responsible for evaluating the necessity, appropriateness and efficiency of the use of ...

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Utilization Review Manager information

See Silver Spring, MD salary details

$40.2K

$93.8K

$172.6K

How much do utilization review manager jobs pay per year?

As of Jun 12, 2026, the average yearly pay for utilization review manager in Silver Spring, MD is $93,798.00, according to ZipRecruiter salary data. Most workers in this role earn between $61,300.00 and $112,900.00 per year, depending on experience, location, and employer.

What jobs pay $2000 a day?

Utilization Review Managers typically do not earn $2000 a day; such high daily rates are more common in specialized consulting, executive roles, or highly paid medical professionals. Most jobs with daily earnings of this level require extensive experience, certifications, or work in high-demand industries like finance, law, or executive management.

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 job makes $10,000 a month without a degree?

A Utilization Review Manager can potentially earn around $10,000 per month, especially with extensive experience and certifications in healthcare management or medical review. These roles typically require strong analytical skills, knowledge of medical billing and coding, and the ability to oversee utilization review processes in healthcare settings. While a degree can be helpful, some professionals advance through experience and industry certifications such as Certified Professional in Healthcare Quality (CPHQ).

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

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 jobs in the US pay 300,000 a year?

Utilization Review Managers in healthcare or insurance industries can earn around $300,000 annually with extensive experience, advanced certifications, and leadership responsibilities. High-paying roles often require strong analytical skills, knowledge of medical billing and coding, and proficiency with healthcare management software. Executive-level positions in healthcare organizations may also reach or exceed this salary level.

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.

What does a utilization review manager do?

A utilization review manager oversees the process of evaluating medical services to ensure they are necessary, appropriate, and cost-effective. They coordinate with healthcare providers, review patient records, and ensure compliance with insurance and regulatory standards, often using specialized software. This role requires strong analytical skills and knowledge of healthcare policies and insurance guidelines.
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Utilization Review Manager jobs near you
Utilization Review Nurse RN

Utilization Review Nurse RN

LifeBridge Health

Baltimore, MD

Full-time

Posted 15 days ago

LifeBridge Health rating

6.3

Company rating: 6.3 out of 10

Based on 76 frontline employees who took The Breakroom Quiz

663rd of 871 rated healthcare providers

Job description

Who We Are:
LifeBridge Health is a dynamic, purpose-driven health system redefining care delivery across the mid-Atlantic and beyond, anchored by our mission to “improve the health of people in the communities we serve.” Join us to advance health access, elevate patient experiences, and contribute to a system that values bold ideas and community-centered care.

About the Role/Unit:
The Utilization Review RN at Sinai Hospital works with stakeholders in the Revenue Cycle Management process and payors to ensure efficiency of utilization of resources, minimize losses and maximize reimbursement.

Key Responsibilities:

  • Medical necessity review of patient stays and referral to the physician advisor as needed
  • Denial Management, including coordination with Case Management
  • Monitor utilization of hospital resources

Requirements:

  • Education: BSN preferred; ADN required
  • Licensure: Registered Nurse License - Current Maryland license or Compact Multistate License
  • Experience: At least 2 years of experience in acute inpatient utilization review required

Must Live in One of the Following Districts/States: District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia

What LifeBridge Health employees say

Pay

Benefits

Hours and flexibility

Workplace

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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

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