Utilization Management Specialist (RN)
Baltimore, MD
Experience: 5
Education: BS, Certification
Category: Healthcare
Contractor Work Model: Remote
Brand: System One
Compensation Range: 51.77 Per Hour
Job ID: 378077
Date Posted: 09/02/2026
Shortcut: http://jobs.systemone.com/ZAZY6H
Job Title: Utilization Management Specialist (RN)
Location: Baltimore, MD
Type: Contract To Hire
Compensation: Max BR $68 /hr, Mid-Range Pay (MRP) $100,500/yr
Work Model: Remote – offsite
Responsibilities
- Perform prospective, concurrent, and retrospective reviews for authorization, appropriateness of care, and benefit coverage.
- Analyze clinical information, contracts, mandates, medical policies, evidence-based research, and regulatory requirements to determine appropriateness and authorization of clinical services, both medical and behavioral health.
- Reference regulatory mandates, benefit information, Milliman Care Guidelines, Apollo Guidelines, ASAM, Medicare Guidelines, Federal Employee Program, and other accepted medical/pharmaceutical references to determine medical necessity.
- Conduct research on diseases, treatments, and emerging technologies, including high-cost/high-dollar services, to support decisions and recommendations to medical directors.
- Collaborate with medical directors, provider relations, sales, marketing, and contracting teams to ensure appropriate benefit application and negotiate provider case rates.
- Make referrals and contact members or providers for alternative care settings and present educational topics related to cases, diseases, and treatment modalities.
- Document and communicate findings accurately and efficiently throughout the review process.
- 5+ years of Clinical Nursing experience
- 2+ years of Utilization Management or Care Management experience
- RN or LPN license; Compact license for MD required
- Strong computer skills, including proficiency with Windows, PDFs, Excel, and healthcare management software
- Knowledge of managed care, health delivery systems, and clinical guidelines such as CareFirst, NCQA standards, and accreditation requirements
- Excellent written and interpersonal communication skills to engage with members, healthcare professionals, and internal teams
- Ability to handle multiple cases daily and work independently
- Nursing in Emergency or Critical Care preferred; Medicare/Medicaid and DSNIP knowledge strongly preferred
System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. We help clients get work done more efficiently and economically, without compromising quality. System One not only serves as a valued partner for our clients, but we offer eligible employees health and welfare benefits coverage options including medical, dental, vision, spending accounts, life insurance, voluntary plans, as well as participation in a 401(k) plan.
System One is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, age, national origin, disability, family care or medical leave status, genetic information, veteran status, marital status, or any other characteristic protected by applicable federal, state, or local law.
#M-
#LI-
Ref: #851-Rockville-S1
-
Medical Science Director (New England Region)
Parsippany, NJ
Job Title: Medical Science Director/Medical Science Liaison Location: New England Region Type: Direct Hire Compensation: $200,000.00 - $235,000.00 Contractor Work Model: Remote Overview A field-based Medical Science Director will support Medical Affair...
Date Posted: 07/20/2026 Recommended
-
Medical Science Director CA
Parsippany, NJ
Job Title: Medical Science Director/Medical Science Liaison - Northern CA Location: Northern CA Salary: $200,000 - $230,000 Type: Full-time Contractor Work Model: Remote – offsite Responsibilities Support medical affairs activities across oncology, inf...
Date Posted: 07/20/2026 Recommended
-
Medical Director I
New York, NY
Job Title: Medical Director I Location: REMOTE - Must reside in commuting distance to New York, NY Type: Contract - 12 month The medical director, US Medical Affairs for Antivirals will provide support for the US Antiviral Medical strategy to achieve s...
Date Posted: 09/11/2026 Recommended
-
DIRECTOR OF ACUTE CARE SERVICES
Wellsville, NY
Job Title: DIRECTOR OF ACUTE CARE SERVICES Location: Wellsville, NY Type: Direct Hire Contractor Work Model: Onsite DIRECTOR OF ACUTE CARE SERVICES Statement of Purpose: The Director of Acute Care Services manages and coordinates the planning, developm...
Date Posted: 08/03/2026 Recommended
-
Analytical Science Manager
Parsippany, NJ
Job Title: Analytical Science Manager Location: Parsippany, NJ Type: Direct Hire - Full time permanent Compensation: $100,000.00 - $120,000.00 Work Model: Hybrid – 2 days onsite, 3 days work from home Responsibilities Lead analytical method transfers a...
Date Posted: 08/21/2026 Recommended
-
Continuous Improvement Specialist
Albuquerque, NM
Job Title: Continuous Improvement Specialist Location: Albuquerque, NM Type: Contract Compensation: $61-$66.66 Work Model: Onsite – onsite Hours: 40.0 Overview Leading food manufacturing company looking for an experienced Continuous Improvement Special...
Date Posted: 08/19/2026 Recommended
-
Senior Project Manager
Philadelphia, PA
Job Title: Senior Project Manager Location: Philadelphia, PA Type: Direct Hire Compensation: $160,000.00 depending on experience Work Model: Hybrid – onsite and remote (1 day a week onsite, but occasionally more could be required) Hours: 40.0 Responsib...
Date Posted: 07/20/2026 Recommended
-
Pharmacovigilance Systems Analyst
Athens, GA
Job Title: Pharmacovigilance Systems Analyst Location: Athens, GA Type: 21 month contract Compensation: $30-34/hour, depending on qualifications Work Model: Onsite – onsite Hours: 40.0 Overview Provide operational and administrative support for pharmac...
Date Posted: 08/20/2026 Recommended
-
Lead Manufacturing Technician
Vista, CA
Job Title: Lead Manufacturing Technician Location: Vista, CA Type: Contract Compensation: $20 - $25.50 Work Model: Onsite – onsite Hours: 40.0 Responsibilities: Support Supervisor in assigning daily duties to technicians and monitoring processes and pe...
Date Posted: 08/26/2026 Recommended
-
Research Associate
Rockville, MD
Job Title: Research Associate Location: Rockville, MD Type: 6+ month Contract Pay Range: $30.00 - $43.00/hr Hours: Monday-Friday 9AM-5PM Overview Biopharmaceutical Company is seeking a Research Associate, working with animal modeling to support the R&D...
Date Posted: 07/30/2026 Recommended
-
QC Analyst
Novato, CA
Job Title: QC Analyst Location: Novato, CA Type: Contract Compensation: $28.00 - $32.00 Work Model: Onsite – onsite Hours: Wednesday - Saturday (Onsite 4 days), swing shift (1pm-11:30 pm) Overview Leading biotechnology company looking for an experience...
Date Posted: 08/10/2026 Recommended
-
Clinical Research Coordinator
Las Vegas, Nevada
Job Title: Clinical Research Coordinator Location: Las Vegas, NV Type: Contract Compensation: $30.00/hr Work Model: Onsite Hours: 40 hours Responsibilities Assist in the coordination and execution of clinical research protocols under the supervision of...
Date Posted: 09/09/2026 Recommended
-
Clinical Research Coordinator
West Hills, California
Job Title: Clinical Research Coordinator Location: West Hills, California Type: Contract Compensation: $26.00-$30.00/hr Work Model: Onsite – onsite Hours: 40.0 Responsibilities Assist in the coordination and execution of clinical research protocols und...
Date Posted: 07/27/2026 Recommended
-
Director Corporate Communications
Parsippany, NJ
Job Title: Director Corporate Communications Location: Parsippany, NJ Type: Direct Hire - full time permanent direct with our client Compensation: $170,000 - $200,000 base Work Model: Hybrid – onsite Tuesday and Thursday Hours: 40.0 hours per week Over...
Date Posted: 08/04/2026 Recommended
-
Clinical Trial Manager - Associate
Burlington, Ontario
Job Title: Clinical Trial Manager - Associate Location: Burlington, Ontario Type: Contract Compensation: $45 CAD-$50 CAD Work Model: Hybrid – onsite and remote Hours: 40.0 Responsibilities Support the operational set-up, execution, and delivery of assi...
Date Posted: 08/24/2026 Recommended
-
Data Manager (Part-Time)
King of Prussia, PA
Job Title: Data Manager (Part-Time) Location: King of Prussia, PA Type: Contract - 18 months Compensation: $75.00 - $80.00/hr W2 Work Model: Hybrid – onsite and remote Hours: Part time 10-20 hours per week **Please note that we cannot work C2C with any...
Date Posted: 09/09/2026 Recommended
-
QC Analyst - Potency
Rockville, MD
Job Title: QC Analyst - Potency Location: Rockville, MD Type: Contract Schedule: Monday - Friday 8am-5pm Overview Biopharmaceutical Company is seeking a QC Analyst to join their team in Rockville, MD! Responsibilities Perform testing and analysis of po...
Date Posted: 09/08/2026 Recommended
-
OnCore Analyst II Sponsored Research
Pittsburgh, PA
Job Title: OnCore Analyst II Sponsored Research Location: Pittsburgh, PA Type: Direct Hire Work Model: Hybrid – onsite and remote Overview Under the direction of the Senior OnCore Administrator, this technical position contributes to the configuration,...
Date Posted: 08/06/2026 Recommended
-
Quality Assurance Specialist
Ontario, CA
Job Title: Quality Assurance Specialist Location: Ontario, CA Type: Direct Hire Compensation: $70,000 Work Model: Onsite Hours: 40.0 Responsibilities Ensure compliance with FDA regulations, GMP requirements, labeling standards, and retailer compliance ...
Date Posted: 08/19/2026 Recommended
-
Quality Control Technician III
Athens, GA
Job Title: Quality Control Technician III Location: Athens, GA Type: Contract Compensation: $20-$22 Contractor Work Model: Onsite – onsite Hours: 40 hours/week Overview Leading pharmaceutical manufacturing and animal health company looking for an exper...
Date Posted: 09/10/2026 Recommended
-
Samples Registration Technician
Arvada, CO
Job Title: Sample Registration Technician Location: Arvada, CO - Onsite Type: 5 month Contract To Hire Pay: $21-$22/hr Hours: Monday-Friday 10am-7pm Overview A leading environmental testing laboratory is seeking a Sample Registration Technician to supp...
Date Posted: 08/28/2026 Recommended
-
E&I Supervisor
Quincy, MA
Job Title: E&I Supervisor Location: Quincy, MA Type: Direct Hire Compensation: $105,000.00 - $115,000.00 Responsibilities Ensure safety is the top priority in all E&I maintenance activities through strict adherence to safe work practices, permitting re...
Date Posted: 09/03/2026 Recommended
-
Warehouse Inventory Technician
Harleysville, PA
Job Title: Warehouse Inventory Technician Location: Harleysville, PA Schedule: Monday-Friday 9am-1pm Pay Rate: $20-25hr Type: Contract Responsibilities: Receive pharmaceutical products arriving on site. Verify material against supplier packing list. Co...
Date Posted: 07/30/2026 Recommended
-
Manufacturing Tech Central Weigh - 2nd Shift
Branchburg, NJ
Job Title: Manufacturing Tech Central Weigh - 2nd Shift Location: Branchburg, NJ Type: Contract Compensation: $23/hr Work Model: Onsite Hours: Monday through Friday, 3pm to 11:30 PM (2nd shift) Responsibilities • Perform weighing and dispensing of raw ...
Date Posted: 09/10/2026 Recommended
-
Environmental, Health & Safety Coordinator
Redmond, WA
Job Title: Environmental, Health & Safety Coordinator Location: Redmond, WA Type: Contract Work Model: Onsite Hours: M - F 1st Shift Compensation: $25 - $28.61/hr Responsibilities: Assist in implementing and monitoring company environmental safety prog...
Date Posted: 08/31/2026 Recommended
-
Associate Engineering Technician
Portage, MI
Job Title: Associate Engineering Technician Location: Portage, MI Type: Contract Compensation: $25-29/hour Work Model: Onsite Hours: 10pm - 6:30am, beginning Sunday night and ending Friday morning weekly Overview: Provides technical support to engineer...
Date Posted: 09/04/2026 Recommended
-
Medical Biller
Hackettstown, NJ
Job Title: Medical Biller Location: Hackettstown, NJ Type: Contract To Hire Compensation: $20.00 - $25.00 per hour Work Model: Remote – offsite Hours: 9 AM - 5 PM M-F Security Clearance: Not specified Responsibilities • Assist Senior Manager, Billing a...
Date Posted: 09/11/2026 Recommended
-
Associate Engineering Technician - 2nd Shift
Portage, MI
Job Title: Associate Engineering Technician - 2nd Shift Location: Portage, MI Type: Contract Compensation: $25-29/hour Work Model: Onsite Hours: 2nd shift, 2:00pm - 10:30pm, Monday through Friday Overview: Provides technical support to engineering acti...
Date Posted: 09/14/2026 Recommended
-
Associate Engineering Technician
Portage, MI
Job Title: Associate Engineering Technician Location: Portage, MI Type: Contract Compensation: $25-29/hour Work Model: Onsite Hours: 1st shift 6:00am - 2:30pm, Monday through Friday Overview: Provides technical support to engineering activities by assi...
Date Posted: 09/14/2026 Recommended
-
Customer Service Representative
Cary, IL
Job Title: Customer Service Representative Location: Cary, IL Type: Contract Compensation: $22/hr Work Model: Hybrid – onsite and remote Hours: 9:30am - 6pm CST Responsibilities Provide customer services relating to sales, sales promotions, installatio...
Date Posted: 09/08/2026 Recommended