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Utilization Jobs in Maryland (NOW HIRING)

MedStar Health

RN Team Lead Utilization Review

Clinton, MD · On-site

$89K - $162K/yr

Utilization Review Supervisor Candidate must have acute care Utilization Review experience. Candidate must live in the DC/Baltimore region. General Summary of Position Supervises the daily activities ...

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Showing results 21-40

All JobsUtilization JobsUtilization Jobs in Maryland

Utilization information

See Maryland salary details

$20

$41

$66

How much do utilization jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for utilization in Maryland is $41.04, according to ZipRecruiter salary data. Most workers in this role earn between $32.45 and $47.12 per hour, depending on experience, location, and employer.

How to become a utilization reviewer?

To become a utilization reviewer, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of medical coding and insurance policies. Relevant certifications such as Certified Professional Coder (CPC) or Certified Medical Reimbursement Specialist (CMRS) can enhance job prospects. Strong analytical skills and attention to detail are essential for reviewing medical records and determining appropriate service utilization.

What is the difference between Utilization vs Resource Coordinator?

AspectUtilizationResource Coordinator
Primary FocusMeasuring and optimizing how staff time is usedManaging and assigning resources for projects
Required CredentialsOften no specific credentials, but industry experience helpsTypically requires organizational or project management skills
Work EnvironmentCorporate, healthcare, or consulting firmsProject teams, staffing agencies, or departments
Common UsageTracking staff utilization ratesAllocating resources to projects or tasks

Utilization focuses on measuring how effectively staff time is used, often to improve productivity. Resource Coordinator involves actively managing and assigning resources to ensure project needs are met. While related, utilization is more about analysis, and resource coordination is about execution and management.

What is a utilization specialist?

Utilization specialists are professionals who review and evaluate the necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities. They work closely with healthcare providers, insurance companies, and patients to ensure that care is delivered according to established guidelines and that resources are used effectively. Their goal is to help manage costs while ensuring patients receive the appropriate level of care.

What are some of the common challenges faced by utilization review specialists when assessing medical necessity of services?

Utilization Review Specialists often encounter the challenge of balancing patient advocacy with cost-effective care. They must stay updated on evolving insurance policies and clinical guidelines, which can be complex and change frequently. Additionally, coordinating with physicians and healthcare staff to obtain necessary documentation and clarifying treatment plans can be time-consuming. Strong communication skills and attention to detail are essential to ensure timely and accurate reviews, while also maintaining positive working relationships with clinical teams.

What are the key skills and qualifications needed to thrive as a utilization review specialist, and why are they important?

To thrive as a Utilization Review Specialist, you need a background in healthcare (often as an RN or LPN/LVN), strong analytical skills, and knowledge of insurance and medical necessity criteria. Familiarity with utilization management software, ICD-10/CPT coding, and regulatory guidelines like Medicare and Medicaid is typically required. Excellent attention to detail, critical thinking, and effective communication skills set top performers apart in this role. These abilities are crucial to accurately evaluating patient care needs, ensuring regulatory compliance, and optimizing resource use within healthcare organizations.

What are the most commonly searched types of Utilization jobs in Maryland?

The most popular types of Utilization jobs in Maryland are:

What cities in Maryland are hiring for Utilization jobs?

Cities in Maryland with the most Utilization job openings:

Utilization jobs near you
Infographic showing various Utilization job openings in Maryland as of August 2026, with employment types broken down into 2% As Needed, 77% Full Time, 19% Part Time, and 2% Contract. Highlights an 92% Physical, 2% Hybrid, and 6% Remote job distribution, with an average salary of $85,356 per year, or $41 per hour.

Health Services - Spec, Utilization Management

Ampcus

Baltimore, MD • On-site

Other

Re-posted 15 days ago

Job description

Ampcus Inc. is a certified global provider of a broad range of Technology and Business consulting services. We are in search of a highly motivated candidate to join our talented Team.

Job Title: Health Services - Spec, Utilization Management

Location(s): Baltimore, MD

Job Summary:

Utilizing key principles of utilization management, the Utilization Review Specialist (BCBA Licensee) performs prospective, concurrent, and retrospective reviews to determine authorization, medical necessity, and appropriateness of ABA services. The Utilization Management Specialist leverages clinical expertise in behavior analysis, evidence-based ABA practices, and critical thinking skills to evaluate treatment plans, service intensity, and clinical outcomes. This role analyzes clinical documentation, benefit plans, mandates, and medical/behavioral health policies to support determinations related to ABA services for individuals with Autism Spectrum Disorder and other developmental or behavioral diagnoses.

Key Responsibilities:
  • Clinical Review & Authorization Determination (50%): Reviews ABA treatment requests to determine medical necessity, clinical appropriateness, and benefit coverage. Applies behavior analytic principles and clinical expertise to evaluate treatment plans, goals, supervision models, and service intensity.
  • Clinical Analysis & Collaboration (30%): Conducts research and analysis of behavioral health conditions, ABA treatment methodologies, and emerging practices within the field. Collaborates with medical directors, sales and marketing, contracting, provider and member services to determine appropriate benefit application.
  • Care Coordination, Education & Support (20%): Makes appropriate referrals and contacts as appropriate. Offers assistance to members and providers for alternative settings for care. Provides guidance regarding ABA best practices, documentation standards, and authorization requirements.
Required Qualifications:
  • Education Level: Master's Degree or higher in Behavior Analysis, Psychology, Education, or a related field
  • Licensure/Certification: Board Certified Behavior Analyst (BCBA) - Required; Active state licensure as a Behavior Analyst (if applicable in practicing state) - Required
  • Experience: Minimum 3-5 years of clinical ABA experience, including development and supervision of ABA treatment programs
  • Preferred Qualifications: Prior experience in utilization management, care management, or payer-side review of ABA services; Working knowledge of managed care and health delivery systems.

Ampcus is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans or individuals with disabilities.

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About Ampcus

Sourced by ZipRecruiter

Ampcus Inc. is a ISO 20000, ISO 27000, ISO 9001, CMMI DEV/3 SM and CMMI SVC/3 SM certified global provider of a broad range of Technology and Business consulting services. From strategy to execution, our disciplined yet flexible approach starts and ends with our clients. By listening hard and working harder, client goals become our goals. Their success is our satisfaction. It’s why our clients sleep well at night. We believe that the success of an engagement is determined by strong project management, as well as clear communication and mutual commitment working collaboratively. Our methodology begins with listening to the customer about their needs, then working with their team to gain a clear understanding of the requirements, while providing knowledge transfer of best practices for the organization.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Chantilly, VA, US

Year founded

2004

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