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Utilization Jobs in Baltimore, MD (NOW HIRING)

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How much do utilization jobs pay per hour?

As of Sep 8, 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.

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 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.

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 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, 10% Part Time, and 3% Contract. Highlights an 91% Physical, 3% Hybrid, and 6% Remote job distribution, with an average salary of $87,387 per year, or $42 per hour.

Utilization Review Nurse (Full-Time)

GBMC HealthCare

Towson, MD • On-site

Other

Posted 5 days ago

Job description

Utilization Review Nurse

Under general supervision, provides consultative support to the admitting teams concerning patient status determinations and utilization of hospital resources facilitating quality, cost-effective patient outcomes for patients requiring hospital services. Works collaboratively with interdisciplinary staff internal and external to the organization facilitating appropriate status determinations through the utilization review process supporting quality, cost-effective patient outcomes. Responsible for analyzing clinical information and performing timely initial and concurrent reviews using InterQual screening software to identify appropriate medical necessity, length of stay, and level of care based upon evidence based clinical guidelines.

Education

Bachelor of Science in Nursing (BSN) OR Associate of Science in Nursing and currently enrolled in a BSN program with an expected graduation date within three (3) years.

Licensure, Certifications:
  • Current state of Maryland Registered Nurse license
  • Bachelor of Science in Nursing (BSN)
  • Certification in Utilization Management and/or Care Management highly desired.
Experience:

Five (5) years diversified, progressive experience in acute care and/or other settings within the continuum required. Two (2) years of Utilization Review and Case Management experience which includes utilization review processes and discharge planning, and working with Re-Admission Initiatives preferred.

Skills:

· Advanced knowledge of InterQual and/or MCG admission criteria

· Knowledge of healthcare regulatory standards

· Advanced skill in using computer software

· Advanced skill in oral and written communication

· Advanced skill in critical thinking

· Ability to work independently and resolve complex problems

· Ability to remain calm under pressure and intense time constraints

· Ability to assess discharge needs for patients

· Strong analytical and problem-solving skills

· Strong interpersonal communication and influencing skills necessary to interact effectively with physicians, payers, regulatory agencies, staff, and other health professional

· Strong organizational and time management skills

· Ability to operate independently and balance multiple priorities

· Proficiency in electronic medical record review

Principal Duties and Responsibilities:
  • Reviews available electronic medical records during the pre-admission process to determine appropriate patient status, optimizing correct patient classification and corresponding payer notifications.
  • Reviews the appropriateness of admission and continued stay criteria for a defined group of patients
  • Develops initial admission reviews for patients requiring hospital services and provides timely status recommendations to admitting providers a concurrent stay and/or discharge plan of care in accordance with departmental and payer clinical guidelines.
  • Maintains a working knowledge of contractual and clinical criteria guidelines. Coordinates services with managed care companies and other third party payers. Discusses on-site reviewer issues with payer, either via the telephone or in person
  • Assures timely utilization compliance with all payers who require authorizations and clinical submission. Demonstrates knowledge of reimbursement mechanisms. Considers patient's financial resources for meeting healthcare needs (insurance reimbursement, managed care plans, entitlement programs, and personal resources).
  • Participates as an active partner with physicians and interdisciplinary teams, providing education ancillary, and nursing staff regarding admission decisions including status determinations, financial and clinical outcomes, and documentation requirements and standards.
  • Maintains current knowledge on all regulatory changes that affect care delivery or reimbursement of acute care services. Uses knowledge of national and local coverage determinations to appropriately advise physicians.
  • Identifies system obstacles that affect patient outcomes and participates in interdisciplinary decisions and care of the patient. Consults with interdisciplinary team members to address problems, and makes recommendations to problem solve.
  • Assists with discharge planning, by preventing un-necessary hospital utilization, assist in the appropriate return of and placement of patients to post acute care, community based care and appropriate alternate levels of care.
  • Demonstrates mastery in InterQual level of care guidelines. Possesses proficiency in utilization review systems, clinical support systems, and business support applications.
  • Promotes use of evidence-based protocols to influence high quality and cost-effective care.
  • Escalates clinically and financially complex cases to leadership, offering possible solutions through discussion and feedback. Engages regularly in formal and informal dialogue about quality; directly addressing concerns and promoting continuous improvement.
  • Performs concurrent reviews and additional duties as assigned.
All roles must demonstrate GBMC Values:

Respect

I will treat everyone with courtesy. I will foster a healing environment.

  • Treats others with fairness, kindness, and respect for personal dignity and privacy
  • Listens and responds appropriately to others' needs, feelings, and capabilities

Excellence

I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.

  • Meets and/or exceeds customer expectations
  • Actively pursues learning and self-development
  • Pays attention to detail; follows through

Accountability

I will be professional in the way I act, look and speak. I will take ownership to solve problems.

  • Sets a positive, professional example for others
  • Takes ownership of problems and does what is needed to solve them
  • Appropriately plans and utilizes required resources for various job duties
  • Reports to work regularly and on time

Teamwork

I will be engaged and collaborative. I will keep people informed.

  • Works cooperatively and collaboratively with others for the success of the team
  • Addresses and resolves conflict in a positive way
  • Seeks out the ideas of others to reach the best solutions
  • Acknowledges and celebrates the contribution of others

Ethical Behavior

I will always act with honesty and integrity. I will protect the patient.

  • Demonstrates honesty, integrity and good judgment
  • Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers

Results

I will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals.

  • Embraces change and improvement in the work environment
  • Continuously seeks to improve the quality of products/services
  • Displays flexibility in dealing with new situations or obstacles
  • Achieves results on time by focusing on priorities and manages time efficiently

Pay Range

$68,281.18 - $110,274.20

Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.

Equal Employment Opportunity

GBMC HealthCare and its affiliates are Equal Opportunity employers. 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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