Case Reviewer

Job overview

The Case Reviewer role is hybrid, performed remotely Monday through Friday with quarterly in-person training and meetings in Columbia, MD. The listed base pay is $23–$27 per hour. The position supports utilization review for a client described as a population health management organization working with government programs, employers, and health plans. The reviewer applies program criteria to assess Medicaid service requests, verify eligibility, and review medical records for pre-authorization decisions. The role supports timely, accurate review and coordination among clinical reviewers, providers, facilities, and subscribers.

What you'll do

• Make prospective review decisions using established criteria
• screen cases to assess whether care is appropriate
• refer cases that do not meet criteria to an RN or social worker reviewer
• complete reviews within specified timeframes
• liaise with clinical reviewers, providers, facilities, and subscribers
• document medical information accurately and promptly
• respond to provider and consumer inquiries by email and phone.

What we're looking for

Skills & competencies

case reviewer

hybrid

columbia md

remote monday–friday

quarterly in-person training

medicaid

utilization review

medical records

pre-authorization

$23–$27 per hour

population health

monday–friday 8:00 am–5:00 pm est

Work arrangement

• Weekend coverage required

Why this role

Candidates must reside within commuting distance of Columbia, MD and attend quarterly in-person sessions. A bachelor's degree in health or human services and relevant utilization review or healthcare policy experience are preferred.

About the employer

Absolute Staffing & Consulting Solutions is hiring for this role. Industry: Temporary Help Services. Sector: 56.