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Utilization Jobs in Baltimore, MD (NOW HIRING)

Prime Time Healthcare

Utilization Review

Baltimore, MD · On-site

Now Hiring: RN Utilization Review - Baltimore, MD Are you a passionate RN professional looking for a new adventure? Prime Time Healthcare is seeking dynamic individuals like you to join our team in ...

Ampcus

Spec, Utilization Management

Baltimore, MD · On-site

Spec, Utilization Management Job Location: Baltimore, MD Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective ...

ICONMA

Spec, Utilization Management

Baltimore, MD · On-site

Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, concurrent and retrospective reviews for authorization, appropriateness of care ...

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All JobsUtilization JobsUtilization Jobs in Baltimore, MD

Utilization information

See Baltimore, MD salary details

$21

$42

$68

How much do utilization jobs pay per hour?

As of Aug 13, 2026, the average hourly pay for utilization in Baltimore, MD is $42.01, according to ZipRecruiter salary data. Most workers in this role earn between $33.22 and $48.27 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 Baltimore, MD? The most popular types of Utilization jobs in Baltimore, MD are:
Utilization jobs near you
Infographic showing various Utilization job openings in Baltimore, MD as of August 2026, with employment types broken down into 2% As Needed, 85% Full Time, 11% Part Time, and 2% Contract. Highlights an 90% Physical, 2% Hybrid, and 8% Remote job distribution, with an average salary of $87,387 per year, or $42 per hour.

Utilization Reviewer

University of Maryland Medical System

Largo, MD • On-site

$406K/yr

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

Job Requirements
Located in Largo in the heart of Prince George's County, our state-of-the-art regional medical center (University of Maryland Capital Region Medical Center) will provide improved access to primary and ambulatory care services and serve as a tertiary care center for critically ill patients. In addition, our new space will allow us to expand our offerings as a community partner to help improve the health status of Prince George's County residents.
Position Summary:
Under general supervision, provides utilization review and denials management for an assigned patient case load. This role utilizes nationally recognized care guidelines/criteria to assess the patient's need for outpatient or inpatient care as well as the appropriate level of care. The role requires interfacing with the case managers, medical team, other hospital staff, physician advisors and payers.
Primary Responsibilities:
Performs timely and accurate utilization review for all patient populations, using nationally recognized care guidelines/criteria relevant to the payer.
Communicates with clinical care coordinators, physician advisor, medical team and payors as needed regarding reviews and pended/denied days and interventions.
Supports concurrent appeals process through proactive identification of pended/denied days.
Implements the concurrent appeals process with appropriate referrals and documentation.
Ensures appropriate Level of Care and patient status for each patient (Observation, Extended Recovery, Administrative, Inpatient, Critical Care, Intermediate Care, and Med-Surg).
Reviews tests, procedures and consultations for appropriate utilization of resources in a timely manner.
Conducts HINN discussions/Observation Education.
Collaborates with Clinical Care Coordinators concerning Avoidable Days Collection.
Ensures Regulatory Compliance related to Utilization Management conditions of participation.
Assures appropriate reimbursement and stewardship of organizational and patient resources.
Pursues and reports opportunities to improve reimbursement.
Collaborates with admitting specialists regarding authorization policies and procedures of third-party payers. Remains current on clinical practice and protocols impacting clinical reimbursement.
Work Experience
Education Bachelors in Nursing required.
Licensure as a Registered Nurse in the state of Maryland, or eligible to practice due to Compact state agreements outlined through the MD Board of Nursing, is required
One year of experience in case management or utilization management with knowledge of payer mechanisms and utilization management is preferred.
Two years' experience in acute care and four years clinical healthcare experience preferred.
Certified Professional Utilization Reviewer (CPUR) preferred.
Additional experience in home health, ambulatory care, and/or occupational health is preferred.
Knowledge, Skills and Abilities
1. Highly effective verbal and written skills are required.
2. Strong communication skills, self-confidence and experience in working with physicians are required.
3. Excellent analytical and team building skills, as well as the ability to prioritize and work independently are required.
4. The ability to work collaboratively with other disciplines is required.
5. Ability to work with Hospital/ Utilization Management and related software programs is required.
6. Knowledge of utilization management is preferred.
Benefits
Benefits
All your information will be kept confidential according to EEO guidelines.
Compensation:
• Pay Range: $40.61-$60.96
• Other Compensation (if applicable):
• Review the 2024-2025 UMMS Benefits Guide

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