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Chart Utilization Review Jobs in Massachusetts (NOW HIRING)

YO AI Labs

Hospitalist Physician - Remote

Boston, MA · Remote

$70 - $100/hr

Experience with chart review or clinical documentation review . * Experience with clinical documentation improvement (CDI) . * Experience with utilization review, medical coding, or healthcare ...

YO AI Labs

Hospitalist Physician - Remote

Boston, MA · Remote

$70 - $100/hr

Experience with chart review or clinical documentation review . * Experience with clinical documentation improvement (CDI) . * Experience with utilization review, medical coding, or healthcare ...

Behavioral Health Network, Inc.

LPN-OTP

Worcester, MA · On-site

$30.25 - $37.50/hr

Chart medication administration in nurse's notes accurately and in a timely manner, documenting ... Knowledgeable in utilization/review standards, quality assurance, and CARF standards * Able to ...

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Chart Utilization Review information

What is chart utilization review?

Chart Utilization Review is a process commonly used in healthcare settings to assess the necessity, appropriateness, and efficiency of medical services provided to patients. It involves reviewing patient charts and medical records to ensure that treatments and procedures are justified according to established guidelines and policies. This process helps in improving patient care, managing costs, and ensuring compliance with regulatory requirements. Utilization review professionals work closely with medical staff, insurance companies, and regulatory agencies to support quality and cost-effective care.

What are some common challenges faced by professionals in chart utilization review, and how can they be addressed?

Professionals in Chart Utilization Review often encounter challenges such as navigating incomplete or inconsistent medical documentation, staying current with ever-evolving healthcare regulations, and balancing productivity with accuracy. To address these challenges, it is important to maintain open communication with clinical staff, participate in ongoing training, and utilize robust electronic health record systems. Additionally, collaborating closely with interdisciplinary teams can help clarify documentation and ensure compliance with regulatory standards.

What are the key skills and qualifications needed to thrive as a chart utilization review specialist, and why are they important?

To thrive as a Chart Utilization Review specialist, you need a background in healthcare, strong knowledge of medical terminology, and experience with patient care documentation, often supported by an RN or LPN license. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Professional in Utilization Review (CPUR) are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for accurately reviewing charts and collaborating with healthcare providers. These abilities ensure compliance, optimize patient care, and support cost-effective healthcare delivery.

What is the difference between Chart Utilization Review vs Chart Review Specialist?

AspectChart Utilization ReviewChart Review Specialist
CredentialsTypically requires healthcare or insurance-related certificationsOften requires medical or coding certifications
Work EnvironmentHealthcare facilities, insurance companies, utilization management teamsMedical offices, insurance companies, coding firms
Employer & IndustryHospitals, insurance providers, healthcare organizationsMedical billing companies, insurance firms, healthcare providers
Primary FocusAssessing medical necessity and appropriateness of servicesReviewing medical records for coding accuracy and completeness

While both roles involve reviewing medical information, Chart Utilization Review focuses on evaluating the necessity of healthcare services, whereas Chart Review Specialists primarily verify medical documentation for coding and billing accuracy. Understanding these distinctions helps professionals choose the right career path or job search focus.

What are popular job titles related to Chart Utilization Review jobs in Massachusetts?

For Chart Utilization Review jobs in Massachusetts, the most frequently searched job titles are:

What job categories do people searching Chart Utilization Review jobs in Massachusetts look for?

The top searched job categories for Chart Utilization Review jobs in Massachusetts are:

What cities in Massachusetts are hiring for Chart Utilization Review jobs?

Cities in Massachusetts with the most Chart Utilization Review job openings:

Chart Utilization Review jobs near you
Infographic showing various Chart Utilization Review job openings in Massachusetts as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 17% Part Time, 1% Temporary, and 4% Contract. Highlights an 87% Physical, 4% Hybrid, and 9% Remote job distribution.

Sr Utilization Management Nurse RN - Field Position

UnitedHealth Group

Boston, MA • On-site

Full-time

Retirement

Re-posted 17 days ago

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

192nd of 898 rated healthcare providers

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
We serve the Commonwealth of Massachusetts in partnering with onsite audits and projects. We have collaborative team scheduling and there is an occasional opportunity for remote work based on business needs.
As a Sr Utilization Management Nurse in the Boston MA Regional Area, the role centers on ensuring the accuracy of medical record coding, supporting proper payment to nursing facilities, and promoting quality patient care. Responsibilities include collaborating with peers and providers to discuss care details, reviewing clinical information for appropriateness, and communicating findings and rationale to medical professionals and the broader community. Additionally, the nurse educates stakeholders about audit results and corrective plans, ensures compliance with HIPAA guidelines, and leverages clinical expertise to guide decisions and optimize patient outcomes.
Qualified candidates must live in the Boston MA Regional Area to perform the daily travel responsibilities. For this role, there will be no weekends, no holidays, and no on-call work.
If you live in Boston MA, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
  • Audit entire medical record for accuracy of the coding on the MDS to support payment to the nursing facility
  • Auditing anti-psychotic therapy for quality review
  • Discuss Patient Care specifics with peers or providers in overall patient care and benefits
  • Communicate clinical findings and present rationale for decisions to medical professionals and members at the appropriate level for understanding
  • Review the entire medical record for accuracy, and appropriate clinical treatment
  • Communicate findings of audits to client, and community as needed
  • Education of findings with community, identifying plans for correction
  • Comply with HIPAA guidelines related to Personal Health Information (PHI) when communicating with others
  • Leverage experience and understanding of disease pathology to review chart/clinical information, ask appropriate questions, and identify appropriate course of care in a given situation
  • Perform medical chart review that includes a review of current and prior patient conditions, documents, and evaluations, and relevant social and economic situations to identify patients' needs
  • Research and identify information needed to review assessment for accuracy, respond to questions, or make recommendations
  • Apply knowledge of pharmacology and clinical treatment protocol to determine appropriateness of care
  • Work collaboratively with peers/team members and other levels or segments within Optum, UHC, or UBH (e.g. Case Managers, Field Care Advocates) to identify appropriate course of action (e.g. Appropriate care, follow up course of action, make referral)
  • Required to travel within geographic territory (state of Massachusetts) at least 90% of the time (some weeks will require 100% travel as business needs dictate) and assist when needed throughout the state of Massachusetts for audits. (Audits will be conducted onsite)

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • Registered Nurse (RN) with a current, active, unrestricted RN License in Massachusetts
  • Currently have OR be able to obtain an RAC/CT MDS certification (must have completed certification prior to start date)
  • 4+ years of nursing experience, specifically in long-term care and/or medical record review with knowledge of Medicare and Medicaid
  • Recent long-term care MMQ, MDS, staff development or management experience (in long-term care)
  • Experience working within medical insurance and/or healthcare industries
  • Experience analyzing inventory, researching, identifying, and resolving issues
  • Experience with defining and managing processes within a team
  • Experience trouble shooting issues for users within teams, IT, and/or business partners
  • Proven knowledge of healthcare insurance industry (Medicaid, Medicare, CMS)
  • Demonstrated knowledge of process flow of UM, including prior authorization, concurrent authorization, and/or clinical appeal and guidance reviews
  • Must live in the Boston MA Regional Area to conduct daily travel requirements
  • Ability to travel within geographic territory (state of Massachusetts) at least 90% of the time (some weeks will require 100% travel as business needs dictate) and assist when needed throughout the state of Massachusetts for audits. (Audits will be conducted onsite)
  • Must have reliable transportation and be able to provide proof of a valid, unrestricted Driver's License and current Auto Insurance

Preferred Qualifications:
  • Proven knowledge of Medicaid and Medicare benefit products including applicable state regulations
  • Demonstrated knowledge of applicable area of specialization
  • Demonstrated knowledge of Massachusetts DPH guidelines
  • Demonstrated knowledge of computer functionality, navigation, and software applications
  • Proficiency with Microsoft Office Suite
  • Proficient written and verbal skills

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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