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Utilization Reviewer Jobs in Silver Spring, MD (NOW HIRING)

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Utilization Reviewer information

See Silver Spring, MD salary details

$32K

$39.3K

$45.5K

How much do utilization reviewer jobs pay per year?

As of Aug 11, 2026, the average yearly pay for utilization reviewer in Silver Spring, MD is $39,275.00, according to ZipRecruiter salary data. Most workers in this role earn between $35,100.00 and $43,400.00 per year, depending on experience, location, and employer.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How does a utilization reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What does a utilization reviewer do?

A Utilization Reviewer is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient records, treatment plans, and insurance policies to ensure that care meets established guidelines and standards. Their role helps control healthcare costs while maintaining quality patient care and ensuring compliance with regulatory requirements. Utilization Reviewers often communicate with healthcare providers, insurance companies, and patients to gather information and make informed decisions.

What does a utilization reviewer do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

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

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.
More about Utilization Reviewer jobs
What job categories do people searching Utilization Reviewer jobs in Silver Spring, MD look for? The top searched job categories for Utilization Reviewer jobs in Silver Spring, MD are:
What cities near Silver Spring, MD are hiring for Utilization Reviewer jobs? Cities near Silver Spring, MD with the most Utilization Reviewer job openings:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Silver Spring, MD as of August 2026, with employment types broken down into 84% Full Time, 10% Part Time, and 6% Contract. Highlights an 96% In-person, 2% Hybrid, and 2% Remote job distribution, with an average salary of $39,275 per year, or $18.9 per hour.

Utilization Review Nurse - Managed Care

Johns Hopkins Healthcare

Hanover, MD • On-site

Full-time

Medical, Dental, Vision, Retirement, PTO

Re-posted 6 days ago

Johns Hopkins Medicine rating

7.5

Company rating: 7.5 out of 10

Based on 205 frontline employees who took The Breakroom Quiz

234th of 887 rated healthcare providers

Job description

Excel. Empower. Advance. Shine. Belong. Explore. Flourish. Champion.
Make It Happen At Hopkins!
Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States. JHHP is a $2.5B business serving over 400,000 lives with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHP has become a leader in provider-sponsored health plans and is poised for future growth.
About this position:
Work Monday - Friday, the core business hours are 8:00 AM - 5:00 PM
As a Utilization Review Registered Nurse for Johns Hopkins Health Plans, you have the opportunity to use your clinical, managed care, utilization review, and verbal/written communication skills to make a difference in our members' lives. Your in-depth knowledge of the appropriate levels of care makes you a valuable resource to our members when they are in need.
What you'll do:
  • Monitor the appropriateness of care received by plan members in a variety of settings
  • Evaluate member benefits and medical criteria to determine authorization of services
  • Communicate authorization and/or denial of covered services with all parties involved
  • Initiate discharge planning of members

What awaits you:
  • Work-life balance - This is a remote role! Candidates in the following approved states will be given priority: MD, DC, VA, PA, DE, FL
  • Medical, Dental, and Vision Insurance.
  • 403B Savings Plan w/employer contribution.
  • Paid Time off & Paid holidays.
  • Employee and Dependent Tuition assistance benefits.
  • Health and wellness programs and MORE!

What you'll bring:
  • Understanding of managed care delivery systems and utilization management
  • Knowledge and expertise in utilizing various criteria sets (i.e. InterQual)
  • Ability to negotiate and resolve conflicts with external customers.
  • Unencumbered Registered Nurse (RN) license in Maryland (or Compact state)
  • 3+ years' experience as an acute care RN
  • 1+ years' experience in Managed Care/Utilization Review is required

Many organizations talk about transforming the future of healthcare, at Johns Hopkins Health Plans, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHP is the place to call home.
Salary Range: Minimum 39.64/hour - Maximum 61.45/hour. Compensation will be commensurate with equity and experience for roles of similar scope and responsibility. In cases where the range is displayed as a $0 amount, salary discussions will occur during candidate screening calls, before any subsequent compensation discussion is held between the candidate and any hiring authority.
The Hospital reserves the right to modify employee schedules as needed.
We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
Johns Hopkins Health System and its affiliates are an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

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