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Utilization Review Manager Jobs in Silver Spring, MD

ATC Travelers A

Case Manager

Baltimore, MD

$19.75 - $25.50/hr

A Case Manager at Johns Hopkins Medicine facilitates the coordination of care for patients with ... Conducting utilization reviews to ensure that patient stays meet medical necessity criteria as ...

ATC Travelers A

Case Manager

Baltimore, MD

$19.75 - $25.50/hr

A Case Manager at Johns Hopkins Medicine facilitates the coordination of care for patients with ... Conducting utilization reviews to ensure that patient stays meet medical necessity criteria as ...

ATC Travelers A

Case Manager

Baltimore, MD · On-site

$19.75 - $25.50/hr

A Case Manager at Johns Hopkins Medicine facilitates the coordination of care for patients with ... Conducting utilization reviews to ensure that patient stays meet medical necessity criteria as ...

ATC Travelers A

Case Manager

Baltimore, MD

$19.75 - $25.50/hr

A Case Manager at Johns Hopkins Medicine facilitates the coordination of care for patients with ... Conducting utilization reviews to ensure that patient stays meet medical necessity criteria as ...

Networks Connect

Case Manager (RN)

Washington, DC · On-site

$85K - $96K/yr

Clinical reviews and utilization management using nationally recognized criteria * Payer coordination - authorizations, denials, and communication around level-of-care changes to limit financial risk ...

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All JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Silver Spring, MD

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 14, 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.
What are the most commonly searched types of Utilization Review jobs in Silver Spring, MD? The most popular types of Utilization Review jobs in Silver Spring, MD are:
What are popular job titles related to Utilization Review Manager jobs in Silver Spring, MD? For Utilization Review Manager jobs in Silver Spring, MD, the most frequently searched job titles are:
What job categories do people searching Utilization Review Manager jobs in Silver Spring, MD look for? The top searched job categories for Utilization Review Manager jobs in Silver Spring, MD are:
What cities near Silver Spring, MD are hiring for Utilization Review Manager jobs? Cities near Silver Spring, MD with the most Utilization Review Manager job openings:
Utilization Review Manager jobs near you

Case Manager

ATC Travelers A

Baltimore, MD

$19.75 - $25.50/hr

Other

Posted 5 days ago

Job description

A Case Manager at Johns Hopkins Medicine facilitates the coordination of care for patients with complex medical and psychosocial needs. This role focuses on ensuring seamless transitions between levels of care, optimizing resource utilization, and advocating for patient-centered outcomes within a world-class academic medical center.
 
Job Summary
The Case Manager is responsible for assessing, planning, implementing, and evaluating the transition of care for a designated patient population. Working as a key member of the multidisciplinary team, this position identifies barriers to discharge and develops comprehensive plans that address medical, financial, and social requirements. The role balances clinical necessity with fiscal responsibility while maintaining the highest standards of patient safety and satisfaction.
 
Key Responsibilities
  • Performing initial and ongoing clinical assessments to identify patient needs and determine the most appropriate level of care.
  • Developing and coordinating individualized discharge plans in collaboration with physicians, nurses, social workers, and families.
  • Conducting utilization reviews to ensure that patient stays meet medical necessity criteria as defined by insurance providers and regulatory agencies.
  • Identifying and mitigating barriers to timely discharge, such as delays in testing, equipment procurement, or placement in post-acute facilities.
  • Communicating regularly with third-party payers to obtain authorizations and provide clinical updates to ensure reimbursement.
  • Arranging for home health services, durable medical equipment, and placement in skilled nursing or rehabilitation facilities.
  • Providing education and support to patients and families regarding their care plan, community resources, and insurance benefits.
  • Documenting all assessment findings, interventions, and transition plans in the electronic medical record with clinical precision.
  • Participating in daily multidisciplinary rounds to provide updates on discharge status and care coordination efforts.
 
Qualifications and Requirements
  • A valid and unencumbered Registered Nurse license in the state of Maryland or a recognized compact state.
  • Bachelor of Science in Nursing (BSN) from an accredited program is typically required.
  • Current Case Management Certification (CCM) or Accredited Case Manager (ACM) credential is highly preferred or must be obtained within a specified timeframe.
  • Minimum of three years of clinical experience in an acute care setting; prior experience in case management or utilization review is strongly desired.
  • Working knowledge of Milliman Care Guidelines (MCG) or InterQual criteria.
  • Familiarity with Medicare, Medicaid, and private insurance regulations and reimbursement structures.
  • Strong critical thinking, negotiation, and conflict-resolution skills.
  • Excellent written and verbal communication skills for interacting with diverse medical teams and external agencies.
 
Working Conditions
  • Work is primarily performed in an office or clinical unit setting within the hospital.
  • Involves significant time spent on the telephone and utilizing computer systems for documentation and communication.
  • Requires the ability to move between different units and buildings across the hospital campus.
  • May involve high-stress situations when managing complex social cases or urgent discharge requirements.

Equal Opportunity Employer: ATC Healthcare Services is an Equal Opportunity Employer. All applicants will be considered for employment without regards to race, color, religion, age, sex, sexual orientation, gender identity, national origin, veteran or disability status or any other category protected by Federal, State or local law. M/F/D/V EOE

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