Utilization Management Specialist
Baltimore, MD
Experience: 5
Education: BS
Category: Healthcare
Contractor Work Model: Remote
Brand: System One
Job ID: 375580
Date Posted: 06/22/2026
Shortcut: http://jobs.systemone.com/tnOw0d
Utilization Management Specialist (UM / Utilization Review Nurse) — Remote
Location: 100% Remote (U.S.) — Maryland compact/eligibility required
Type: Contract (approx. 3 months; potential extension)
Schedule: Mon–Fri, 8:00am–5:00pm ET (1-hour lunch) - Flex after ramp-up start time between 7:00am–9:00am ET
Pay (W2): USD 51.00/H
Job overview
In this role, you’ll use your clinical background and utilization management experience to review requests for care and determine medical necessity, appropriateness, and benefit coverage. You’ll work fully remote and leverage MCG, medical policy, and regulatory guidelines while collaborating with Medical Directors and internal teams to support timely, accurate authorization decisions.
What you’ll do
- Perform prospective, concurrent, and retrospective utilization reviews (medical + behavioral health).
- Make medical necessity / appropriateness determinations and support prior authorizations.
- Use clinical criteria and policy resources daily (including MCG / Milliman Care Guidelines).
- Review clinical documentation, benefits, and mandates to ensure services align with coverage and guidelines.
- Research diagnoses/treatments and high-cost services; summarize findings and escalate complex cases to Medical Directors as needed.
- Collaborate with internal partners and providers to support benefit application and appropriate levels/settings of care.
- Maintain accurate documentation and protect PHI while managing a busy caseload.
Required qualifications
- Active RN or LPN license (RN preferred) — Maryland compact/eligibility required
- 5+ years clinical nursing experience
- 2+ years care management / utilization management experience
- MCG experience (required)
- Experience supporting Commercial/FEP/Medicare lines of business and applying medical policy/regulatory standards
- Strong critical thinking, written communication, and ability to work independently in a remote setting
- Comfortable with web-based tools + Microsoft Office (Word/Excel/PowerPoint)
- Guiding Care and FACETS (required)
Nice to have
- Critical Care or ER clinical background
- Experience with LCD/NCD, Medicare guidelines, ASAM, or other authorization criteria sets
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-1
#LI-AJ1
Ref: #851-Rockville-S1
-
Sr Manager, Market Access - US - Medical Device
Blue Bell, Pennsylvania
Title: Senior Manager, Market Access & Health Economics Type: Full time, Permanent opportunity Location: 100% remote Salary: 145k-180k with 20% Target Bonus, LTIs, Benefits MUST HAVES: MS degree required (PhD health economics modelling preferred) 5+ ye...
Date Posted: 06/02/2026 Recommended
-
Risk Based Quality Management (RBQM) Specialist
Plainsboro, NJ
Job Title: Risk Based Quality Management (RBQM) Specialist Location: REMOTE Type: Contract Compensation: $75 an hour W2 Contractor Work Model: Remote Hours: 40.0 Overview Responsibilities Support clinical trial teams in designing, monitoring, and execu...
Date Posted: 06/18/2026 Recommended
-
Contracts Specialist
Plainsboro, New Jersey
Job Title: Contracts Specialist Location: Remote Type: Contract Compensation: $95,000.00 annual Hours: 40.0 Responsibilities Review clinical trial protocols and develop investigator-specific budgets and site contracts for North American Clinical Operat...
Date Posted: 06/15/2026 Recommended
-
Governance Risk & Compliance Analyst
Lakewood, CO
Job Title: Governance Risk & Compliance Analyst Location: Lakewood, CO Work Model: Hybrid – onsite and remote Overview System One is seeking a GRC Analyst for an opportunity in Lakewood, CO. The GRC Analyst is a member of the Governance, Risk & Complia...
Date Posted: 06/17/2026 Recommended
-
QA Product Manager (Sterile Products)
Florham Park, New Jersey
Job Title: QA Product Manager (Sterile Products) Location: Florham Park, New Jersey Type: Contract Compensation: $45-$59 per hour dependent on years of experience and education. Contractor Work Model: Hybrid – onsite and remote Hours: 40.0 hours per we...
Date Posted: 06/16/2026 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: 06/08/2026 Recommended
-
Medical Science Director (New England Region)
Parsippany, NJ
Job Title: Medical Science Director Location: Parsippany, NJ Type: Direct Hire Compensation: $200,000.00 - $235,000.00 Contractor Work Model: Remote Hours: 40.0 Overview A field-based Medical Science Director will support Medical Affairs through compli...
Date Posted: 05/27/2026 Recommended
-
Regulatory Operations Documentation Specialist
Florham Park, New Jersey
Job Title: Regulatory Operations Documentation Specialist Location: Florham Park, New Jersey Type: 12-month Contract Compensation: $31.00 – $54.00 per hour Contractor Work Model: Remote Hours: 40.0 hours per week Overview This role will support the Reg...
Date Posted: 06/22/2026 Recommended
-
Director Medical Monitor
Parsippany, NJ
Job Title: Director Medical Monitor Location: Parsippany, NJ Type: Direct Hire Contractor Work Model: Hybrid – onsite Overview Responsibilities Provide medical oversight for assigned clinical studies from study start-up through closeout. Participate in...
Date Posted: 06/17/2026 Recommended
-
Project Manager
Raritan, NJ
Job Title: Project Manager Location: Raritan, NJ Type: 9-months contract (40 hrs/week) Compensation: $120,000 - $140,000 with benefits, PTO and holidays Work Model: Hybrid – 2 days onsite, 3 days remote Overview The Global Medical Affairs Project Manag...
Date Posted: 06/22/2026 Recommended
-
Medical Science Director (Mountain Plains)
Parsippany, NJ
Job Title: Medical Science Director/Medical Science Liaison - (Central/Mountain Plains) Location: Colorado, Iowa, Kansas, Nebraska, Nevada, North Dakota, Wyoming Type: Direct Hire Compensation: $200,000.00 - $235,000.00 Contractor Work Model: Remote – ...
Date Posted: 06/10/2026 Recommended
-
Medical Science Director (Ohio Valley)
Parsippany, NJ
Job Title: Medical Science Director (South Central) Location: - LA, KY, MS, MO, TN Type: Direct Hire Compensation: $200,000.00 - $220,000.00 Work Model: Remote Hours: 40.0 Overview Responsibilities Support medical affairs activities across oncology, in...
Date Posted: 06/10/2026 Recommended
-
Central Weight Lab Tech - 2nd Shift
Branchburg, NJ
Job Title: Central Weight Lab Tech - 2nd Shift Location: Branchburg, NJ Type: Contract Compensation: $24.00/hr Contractor Work Model: Onsite Responsibilities Perform weighing and dispensing of raw materials for process orders, inventory management, and...
Date Posted: 05/19/2026 Recommended
-
FP&A Manager (R&D)
Lakewood, CO
Job Title: FP&A Manager (R&D) Location: Lakewood, CO Type: Direct Hire Compensation: $107,000.00 - $134,900.00 Work Model: Hybrid – onsite and remote Responsibilities Lead financial planning, forecasting, and performance management for global R&D organ...
Date Posted: 05/04/2026 Recommended
-
Senior Customer Service Representative
Kalamazoo, MI
Job Title: Pre-Operative Planning Representative Location: Kalamazoo, MI Type: 18 month contract Compensation: $20/hour Contractor Work Model: Onsite Hours: Monday–Friday, 7:00 am to 3:30 pm; overtime may be required Overview The Pre-Operative Planning...
Date Posted: 06/15/2026 Recommended
-
CRA II
Exton, PA
Job Title: CRA II Location: Must be Mid-West based in the United States Type: Direct Hire, full time permanent direct with the client Salary Range: $82,000 - $107,000 commemorate with level of experience Model: Hybrid – onsite and remote Hours: 40.0 Lo...
Date Posted: 06/05/2026 Recommended
-
Sr Financial Analyst
Lakewood, CO
Job Title: Sr Financial Analyst Location: Lakewood, CO Type: Direct Hire Compensation: $75,200.00 - $94,000.00 Work Model: Hybrid – onsite and remote Responsibilities Support enterprise-level financial planning, forecasting, reporting, and strategic an...
Date Posted: 06/02/2026 Recommended
-
Senior Legal Operations Specialist
Florham Park, New Jersey
Job Title: Senior Legal Operations Specialist Location: Florham Park, New Jersey Type: 6-month Contract Compensation: $31.00 - $54.00 per hour (dependent on experience) Contractor Work Model: Hybrid – onsite and remote Hours: 40.0 hours per week Respon...
Date Posted: 05/28/2026 Recommended
-
Research Coordinator
Boston, MA
Job Title: Research Coordinator Location: Boston MA Type: Contract To Hire Compensation: $25-$28/hr Contractor Work Model: Onsite – onsite Hours: 40.0 Responsibilities Assist Sr. Project Manager and team members with all phases of clinical research, in...
Date Posted: 06/15/2026 Recommended
-
Sourcing Analyst
Cary, Illinois
Job Title: Sourcing Analyst Location: Cary, Illinois Type: 3 month- contract Compensation: $30-36/hr Work Model: Onsite Overview: Join a leading medical technology organization as a Sourcing Analyst, driving supplier strategy, negotiations, and supply ...
Date Posted: 06/22/2026 Recommended
-
HR Coordinator II
Tampa, FL
Job Title: HR Coordinator II Location: Tampa, FL Type: Contract Compensation: $32-$36.28/hr depending on qualifications Work Model: Hybrid Hours: 40.0 Overview Leading pharmaceutical company looking for an experienced HR Coordinator. Ideal candidates s...
Date Posted: 06/22/2026 Recommended
-
Maintenance Technician I/111 - Extrusion
Lakewood, CO
Job Title: Maintenance Technician I/III - Extrusion Location: Lakewood, CO Type: Direct Hire Compensation: $24-$36-40/hr + up to 7% annual bonus Work Model: Onsite Hours: Friday-Monday, 7:00AM-5:30PM, will originally train on a Monday-Friday Responsibi...
Date Posted: 06/22/2026 Recommended
-
Warehouse/Distribution Operator
Plainfield, IN
Job Title: Warehouse/Distribution Operator Location: Plainfield, IN Type: Contract Compensation: $24.61 - $28.97 (Based on experience) Contractor Work Model: Onsite Hours: TBD Position Summary We are seeking an experienced Warehouse Distribution Operat...
Date Posted: 06/17/2026 Recommended
-
Medical Science Director Northern CA
Parsippany, NJ
Job Title: Medical Science Director/Medical Science Liaison - Northern CA Location: Parsippany, NJ, United States Type: Full-time Contractor Work Model: Remote – offsite Responsibilities Support medical affairs activities across oncology, infectious di...
Date Posted: 06/17/2026 Recommended
-
Strategic Account Manager (Central South)
Bethlehem, Pennsylvania
Job Title: Strategic Account Manager (Central South) Location: Candidates must be located in TX, LA, OK or AR Type: Direct Hire Compensation: $90K – $115K base + $39K IC (uncapped) Contractor Work Model: Remote – offsite (4 days per week of travel requ...
Date Posted: 06/16/2026 Recommended
-
Senior Process Engineer
Tempe, Arizona
Job Title: Senior Process Engineer Location: Tempe, Arizona Type: Contract Compensation: $58- $64/hr Work Model: Hybrid 4 days onsite, 1 day remote Overview Join a leading medical technology organization where you'll play a key role in bringing innovat...
Date Posted: 06/15/2026 Recommended
-
Animal Technician
Boston, Massachusetts
Job Title: Animal Technician Location: Boston, Massachusetts Type: Contract To Hire Compensation: $21 hourly Contractor Work Model: Onsite – onsite Hours: 7:00am to 3:30pm; Mon-Fri Responsibilities Perform animal husbandry tasks, including providing fo...
Date Posted: 06/18/2026 Recommended
-
Senior Sourcing Supplier Data Analyst
San Jose, California
Job Title: Senior Sourcing Supplier Data Analyst Location: San Jose, CA Type: Contract Compensation: $48-55.61/hr Contractor Work Model: Hybrid oin a fast-paced, innovation-driven medical technology organization where strategic sourcing and data-driven...
Date Posted: 05/28/2026 Recommended
-
Medical Science Director Southern CA
Parsippany, NJ
Job Title: Medical Science Director/Medical Science Liaison - Southern CA Location: Southern, CA Type: Direct Hire Compensation: $200,000.00 - $235,000.00 Contractor Work Model: Remote – offsite Responsibilities Support medical affairs activities acros...
Date Posted: 05/28/2026 Recommended
-
Histology Associate
Oro Valley, AZ
Job Title: Histology Associate Location: Oro Valley, AZ Work Model: Onsite Hours: 1st shift (6:00AM to 2:30PM) Compensation: $25.50/hr Type: Contract, Potential for extension or conversion to permanent Responsibilities Histotechniques (Tissue Sectionin...
Date Posted: 06/22/2026 Recommended