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Insurance Utilization Review Jobs in Massachusetts

US Tech Solutions

Utilization Review Nurse

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

Lifepoint Health

Specialist, Utilization Review

Holyoke, MA · On-site

$33.22 - $44.85/hr

Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued ... UR contacts external case managers/managed care organizations for certification of insurance ...

Lifepoint Health

Specialist, Utilization Review

Holyoke, MA · On-site

$33.22 - $44.85/hr

Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued ... UR contacts external case managers/managed care organizations for certification of insurance ...

Acadia Healthcare

Utilization Specialist

Haverhill, MA · On-site

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 ...

Beth Israel Lahey Health

Utilization Nurse

Plymouth, MA · On-site

$37.14 - $82.22/hr

Reviews admission data to establish the appropriate level of care using Interqual criteria ... Knowledge of government and insurance company reimbursement policies in regards to admission ...

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All JobsInsurance Utilization Review JobsInsurance Utilization Review Jobs in Massachusetts

Insurance Utilization Review information

See Massachusetts salary details

$23

$46

$75

How much do insurance utilization review jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for insurance utilization review in Massachusetts is $46.18, according to ZipRecruiter salary data. Most workers in this role earn between $36.49 and $53.03 per hour, depending on experience, location, and employer.

What is an insurance utilization review?

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.

What are the key skills and qualifications needed to thrive in insurance utilization review?

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.

What are the most common challenges faced by insurance utilization review professionals?

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.

How do I get into an insurance utilization review?

To become an insurance utilization review specialist, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of insurance policies and medical terminology. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or similar credentials can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and insurance software systems.

Is insurance utilization review a stressful job?

Insurance utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. Reviewers often handle complex cases and must balance policy guidelines with patient needs, which can contribute to job pressure. However, the level of stress varies depending on workload, work environment, and individual coping skills.

What are the most commonly searched types of Insurance Utilization Review jobs in Massachusetts?

The most popular types of Insurance Utilization Review jobs in Massachusetts are:

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

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

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

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

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

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

Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Massachusetts as of August 2026, with employment types broken down into 50% Full Time, and 50% Part Time. Highlights an 50% In-person, and 50% Hybrid job distribution, with an average salary of $96,048 per year, or $46.2 per hour.

Utilization Review Clinician

TaraVista Behavioral Health

Holyoke, MA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 14 days ago

Job description

Join us as a Utilization Review Clinician!

Schedule: Monday - Friday, 40 hours, onsite 5 days a week.

As a Utilization Review Clinician for MiraVista in Holyoke, Massachusetts, youll bring your experience and knowledge where your voice matters. A Utilization Review Clinician is an integral part of our multidisciplinary team.

As a Utilization Review Clinician:

  • You will be an active participant in the health care team.

  • You are responsible for pre-certification, concurrent and discharge reviews, appeals and denials, and the compliance of contracted quality measures identified by managed care organizations.

  • You will serve as liaison between the hospital and outside payor sources in accordance with the mission and core principals of MiraVista Behavioral Health Center.

The Utilization Review Clinician will have the following:

  • Master's level clinician or RN.

  • Previous utilization management, preferably in an inpatient psychiatric setting

  • License eligible (LMHC or LICSW preferred) or RN

  • Possess sufficient knowledge regarding clinical treatment of psychiatric patients, the mental health care delivery system, and the managed care environment

  • Display excellent communication skills and an ability to integrate clinical and financial information in the context of an overall utilization management program

  • Requires the ability to work in a multidisciplinary, fast paced environment with a demonstrated sense of autonomy and professionalism.

When you join the growing MiraVista team as a Utilization Review Clinician, youll receive:

  • Medical, Dental, and Vision

  • 401(k) match

  • Employer paid long term disability (LTD)

  • Short term disability (STD)

  • Employer paid life and AD&D Insurance

  • Generous Paid Time Off

  • Flexible Spending Account

  • Tuition Reimbursement

Pay Range:

Compensation will be determined based on the candidate's relevant experience.

$80,000 - $90,000

MiraVista is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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