Canton, MA · On-site
$55 - $60/hr
Previous Managed Care, Health Plan, Medicare, Medicaid, or Commercial Insurance experience. * Strong knowledge of: * Utilization Management (UM) * Medical Necessity Review * Prior Authorization
New
Canton, MA · On-site
$55 - $60/hr
Previous Managed Care, Health Plan, Medicare, Medicaid, or Commercial Insurance experience. * Strong knowledge of: * Utilization Management (UM) * Medical Necessity Review * Prior Authorization
New
Tewksbury, MA · On-site
Uniti Med is seeking a travel Utilization Review for a travel job in Tewksbury, Massachusetts ... Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License reimbursement for ...
Tewksbury, MA · On-site
Uniti Med is seeking a travel Utilization Review for a travel job in Tewksbury, Massachusetts ... Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License reimbursement for ...
Responsibilities Utilization Review Coordinator Opportunity - HRI Hospital is seeking a Full-time ... insurance offering, a physician network and various related services located in 40 U.S. states ...
Responsibilities Utilization Review Coordinator Opportunity - HRI Hospital is seeking a Full-time ... insurance offering, a physician network and various related services located in 40 U.S. states ...
Responsibilities Utilization Review Coordinator Opportunity - HRI Hospital is seeking a Full-time ... insurance offering, a physician network and various related services located in 40 U.S. states ...
Responsibilities Utilization Review Coordinator Opportunity - HRI Hospital is seeking a Full-time ... insurance offering, a physician network and various related services located in 40 U.S. states ...
Devens, MA · On-site
Join us as a Utilization Review Clinician! Schedule: Monday - Friday, 40 hours onsite. As a ... Employer paid life and AD&D Insurance * Generous Paid Time Off * Flexible Spending Account
Devens, MA · On-site
Join us as a Utilization Review Clinician! Schedule: Monday - Friday, 40 hours onsite. As a ... Employer paid life and AD&D Insurance * Generous Paid Time Off * Flexible Spending Account
Pembroke, MA · On-site
$5.0K/mo
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working ... Experience in Utilization Management either with a provider, insurance or HMO organization.
New
Pembroke, MA · On-site
$5.0K/mo
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working ... Experience in Utilization Management either with a provider, insurance or HMO organization.
New
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working ... Experience in Utilization Management either with a provider, insurance or HMO organization.
New
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working ... Experience in Utilization Management either with a provider, insurance or HMO organization.
New
Pembroke, MA · On-site
$5.0K/mo
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working ... Experience in Utilization Management either with a provider, insurance or HMO organization.
New
Pembroke, MA · On-site
$5.0K/mo
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working ... Experience in Utilization Management either with a provider, insurance or HMO organization.
New
Pembroke, MA · On-site
$5.0K/mo
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working ... Experience in Utilization Management either with a provider, insurance or HMO organization.
Pembroke, MA · On-site
$5.0K/mo
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working ... Experience in Utilization Management either with a provider, insurance or HMO organization.
Hingham, MA · On-site
$42.18 - $51.56/hr
The Role The Physical Therapy Utilization Management Reviewer is responsible for evaluating the ... Understand member insurance products and benefits and apply benefits appropriately * Learn and ...
Hingham, MA · On-site
$42.18 - $51.56/hr
The Role The Physical Therapy Utilization Management Reviewer is responsible for evaluating the ... Understand member insurance products and benefits and apply benefits appropriately * Learn and ...
Hingham, MA · On-site
$42.18 - $51.56/hr
The Role The Physical Therapy Utilization Management Reviewer is responsible for evaluating the ... Understand member insurance products and benefits and apply benefits appropriately * Learn and ...
Hingham, MA · On-site
$42.18 - $51.56/hr
The Role The Physical Therapy Utilization Management Reviewer is responsible for evaluating the ... Understand member insurance products and benefits and apply benefits appropriately * Learn and ...
PURPOSE STATEMENT: Proactively monitor utilization of services for patients to optimize ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
PURPOSE STATEMENT: Proactively monitor utilization of services for patients to optimize ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Proactively monitor utilization of services for patients to optimize reimbursement for the facility ... Conduct reviews, in accordance with certification requirements, of insurance plans or other managed ...
Utilization Review * Discipline: RN * Start Date: 08/24/2026 * Duration: 10 weeks * 40 hours per ... Medical, Dental and Vision Insurance with Day 1 Options * 401(k) Plan * Weekly Payroll Deposit
Utilization Review * Discipline: RN * Start Date: 08/24/2026 * Duration: 10 weeks * 40 hours per ... Medical, Dental and Vision Insurance with Day 1 Options * 401(k) Plan * Weekly Payroll Deposit
Salem, MA · On-site
$1.8K - $2.7K/wk
Utilization Review * Discipline: RN * Start Date: ASAP * Duration: 13 weeks * 36 hours per week ... Short-term disability, life insurance, paid jury duty * Access to the largest network of facilities ...
Salem, MA · On-site
$1.8K - $2.7K/wk
Utilization Review * Discipline: RN * Start Date: ASAP * Duration: 13 weeks * 36 hours per week ... Short-term disability, life insurance, paid jury duty * Access to the largest network of facilities ...
Hingham, MA · On-site
$104K - $127K/yr
This role directs the utilization review clinical team operations for our Commercial plans. The ... We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance ...
Hingham, MA · On-site
$104K - $127K/yr
This role directs the utilization review clinical team operations for our Commercial plans. The ... We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance ...
Review the entire medical record for accuracy, and appropriate clinical treatment * Communicate ... Proven knowledge of healthcare insurance industry (Medicaid, Medicare, CMS) * Demonstrated ...
Review the entire medical record for accuracy, and appropriate clinical treatment * Communicate ... Proven knowledge of healthcare insurance industry (Medicaid, Medicare, CMS) * Demonstrated ...
Review the entire medical record for accuracy, and appropriate clinical treatment * Communicate ... Proven knowledge of healthcare insurance industry (Medicaid, Medicare, CMS) * Demonstrated ...
Review the entire medical record for accuracy, and appropriate clinical treatment * Communicate ... Proven knowledge of healthcare insurance industry (Medicaid, Medicare, CMS) * Demonstrated ...
Utilization Review * Discipline: RN * Start Date: 08/24/2026 * Duration: 13 weeks * 36 hours per ... Short-term disability, life insurance, paid jury duty * Access to the largest network of facilities ...
Utilization Review * Discipline: RN * Start Date: 08/24/2026 * Duration: 13 weeks * 36 hours per ... Short-term disability, life insurance, paid jury duty * Access to the largest network of facilities ...
$23.36 - $28.09
2% of jobs
$28.09 - $32.82
9% of jobs
$36.05 is the 25th percentile. Wages below this are outliers.
$32.82 - $37.54
21% of jobs
The median wage is $41.37 / hr.
$37.54 - $42.27
23% of jobs
$42.27 - $46.99
13% of jobs
$50.67 is the 75th percentile. Wages above this are outliers.
$46.99 - $51.72
10% of jobs
$51.72 - $56.44
8% of jobs
$56.44 - $61.17
5% of jobs
$61.17 - $65.90
5% of jobs
$65.90 - $70.62
2% of jobs
$70.62 - $75.35
2% of jobs
$23
$46
$75
One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.
To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.
An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.
$55-$60 per hour
Canton, MA
Contract
Duration: 6 Month Contract (Possibility of Extension)
Position Overview
We are seeking an experienced Utilization Management (UM) Registered Nurse to support outpatient utilization review and prior authorization activities for a leading healthcare organization. The ideal candidate will have a strong background in managed care, utilization management, medical necessity review, prior authorization, and outpatient clinical review.
This role is responsible for reviewing medical records, evaluating the medical necessity of requested services using established clinical guidelines, collaborating with physicians and healthcare providers, and ensuring timely authorization decisions while maintaining compliance with regulatory standards.
Key Responsibilities
Perform outpatient utilization management (UM) and medical necessity reviews for prior authorization and precertification requests.
Review clinical documentation and determine benefit eligibility using evidence-based clinical guidelines and health plan policies.
Evaluate requests for outpatient procedures, surgeries, imaging, therapies, specialty medications, and other healthcare services.
Ensure all utilization review activities meet regulatory turnaround time requirements.
Collaborate with Medical Directors for complex cases, denial recommendations, and clinical escalations.
Communicate authorization decisions with physicians, provider offices, hospitals, and healthcare facilities.
Participate in appeal reviews and provide clinical recommendations when appropriate.
Maintain accurate documentation within utilization management systems.
Monitor cases for quality, compliance, and adherence to organizational policies.
Identify opportunities for process improvement and contribute to quality initiatives.
Serve as a clinical resource for internal teams regarding utilization management guidelines and medical necessity criteria.
Required Qualifications
Active, unrestricted Registered Nurse (RN) license.
Associate Degree in Nursing (ADN) required.
Minimum 5 years of RN clinical experience.
Minimum 3-5 years of Utilization Management (UM), Case Management, Prior Authorization, or Medical Management experience.
Previous Managed Care, Health Plan, Medicare, Medicaid, or Commercial Insurance experience.
Strong knowledge of:
Utilization Management (UM)
Medical Necessity Review
Prior Authorization
Precertification
InterQual and/or MCG Guidelines
Experience reviewing outpatient clinical services.
Excellent clinical assessment and critical thinking skills.
Strong communication skills with providers and interdisciplinary teams.
Ability to work independently in a remote environment.
Comfortable using multiple systems while managing a high-volume workload.
Preferred Qualifications
BSN preferred.
Experience with outpatient utilization management.
Experience using InterQual and/or MCG clinical criteria.
Experience with Medicare Advantage or Commercial Health Plans.
Previous experience with appeals, grievances, or denial reviews.
Knowledge of NCQA, CMS, and utilization management regulatory requirements.
Note:
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
AI Statement: By applying, you acknowledge that AI-assisted tools may be used during hiring.
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US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.
It services
1,001 - 5,000 Employees
Jersey City, NJ, US
2000
