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Insurance Utilization Review Jobs in Massachusetts

Axelon

Prior Authorization Clinician

Charlestown, MA · On-site

$50/hr

Candidates with only home care insurance experience. Job Summary: The Prior Authorization Clinician ... Performs utilization review activities, including pre-certification, concurrent and retrospective ...

Axelon

Prior Authorization Clinician

Boston, MA · On-site

$50/hr

... insurance side; provider side is completely irrelevant. The only thing they review is home care ... • Performs utilization review activities, including pre-certification, concurrent and ...

STI

Case Manager - Registered Nurse

Cambridge, MA · On-site

Primary Responsibilities : 1. Performs utilization review and discharge planning to inpatient ... insurance, contractual, and regulatory requirements as mandated. 11. Abides by MACIPA Case ...

STI

Case Manager - Registered Nurse

Cambridge, MA · On-site

Primary Responsibilities : 1. Performs utilization review and discharge planning to inpatient ... insurance, contractual, and regulatory requirements as mandated. 11. Abides by MACIPA Case ...

Superbeo

RN-Case Manager

Cambridge, MA · On-site

Primary Responsibilities: 1. Performs utilization review and discharge planning to inpatient ... insurance, contractual, and regulatory requirements as mandated. 11. Abides by MACIPA Case ...

Veterans Inc

Billing Specialist

Shrewsbury, MA · On-site

$26.44 - $31.25/hr

You will also collaborate closely with admissions, clinical staff, utilization review, and our ... Maintain precise insurance records within the EHR and communicate coverage limitations or ...

Veterans Inc

Billing Specialist

Shrewsbury, MA · On-site

$26.44 - $31.25/hr

You will also collaborate closely with admissions, clinical staff, utilization review, and our ... Maintain precise insurance records within the EHR and communicate coverage limitations or ...

Veterans Inc.

Billing Specialist

Shrewsbury, MA · On-site

$19.50 - $26.50/hr

You will also collaborate closely with admissions, clinical staff, utilization review, and our ... Maintain precise insurance records within the EHR and communicate coverage limitations or ...

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All JobsInsurance Utilization Review JobsInsurance Utilization Review Jobs in Massachusetts

Insurance Utilization Review information

See Massachusetts salary details

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$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.

Case Manager - Part Time 24-40 Hours

Whittier Health Network

Westborough, MA • On-site

$33.87 - $48.91/hr

Part-time

Medical, Dental, Life, Retirement

Re-posted 11 hours ago

Job description

Case Manager -Part Time , 24-40 HOURS
Whittier Rehabilitation Hospital is a small community hospital that does big things to help people. Our two hospital units specialize in caring for medically complex patients with a similar acuity to a medical surgical or telemetry unit. With our population typically staying for 2-3 weeks, caregivers see the same patients make progress over time.
Essential:
  • Meet with every patient/family within 1 working day of admission to introduce case management and begin an assessment of potential discharge planning needs. Take into account patient's age and developmental level, cultural and religious practices, language and emotional barriers, healthcare needs, financial situation and family/community support.
  • Provide the patient and family information, in a form that they can understand, about the rehabilitation process, levels of care, homecare services, community resources and patient rights including Advance Directives.
  • Attend all interdisciplinary team meetings (RTC, FTC, TTC) to collaborate with the healthcare team, patient and family to establish a treatment plan with realistic goals and a target date to achieve the goals. Identify variables that may influence the accomplishment of the goals. Continually evaluate the effectiveness of the plan and modify as needed.
  • Collaborate with the healthcare team, patient and family for a timely discharge to the next level of care, when appropriate. Assist the team in identifying agencies or facilities that can meet the patient's healthcare needs
  • Make referrals to the next level of care and coordinate the transfer to maintain a continuation of services. Counsel with the patient/family and the payor to coordinate funding for the services. Obtain approval numbers from payor, if needed.
  • Organize all referral paperwork needed to make discharge referral, review for completeness and fax (or have faxed) to the agency or facility that will continue to provide service.
  • Maintain patient privacy and confidentiality at all times. Release only information authorized by the patient/responsible party, and only the specific information required.
  • Case managers will act as utilization review coordinators.
  • At each Rehab Team Conference (RTC) the patient's level of care will be monitored, per UR plan.
  • Refer any cases requiring medical judgment to a physician advisor.
  • Maintain timely contact with external case managers and third party payors as required under "continued stay review" programs. Obtain approvals for continuation of the treatment plan. Advocate for services at an appropriate intensity to best meet the patient's needs.
  • Notify members of the team and business office of any exclusions or level of care changes.
  • Attend Utilization Review Committee meetings, as assigned.
  • Keep patient and family informed of Utilization Review decisions and provide discharge planning options to meet patient care needs.
  • Document all case management activities in the patient's medical record, including notes related to conversations with patient/family, insurers and others in accordance with laws, regulations and hospital policy.
  • Participate in hospital-wide or department specific performance improvement initiatives as assigned.

PREREQUISITES:
  • Registered Nurse; with a minimum of 5 years varied nursing experience, preferably orthopedic, med-surg, geriatric or rehabilitation. Case management experience, preferred.
  • Excellent communication (written and verbal), interpersonal and organization skills.
  • Ability to assess, analyze, plan, implement and evaluate.
  • Basic knowledge of insurance, including an understanding of eligibility, benefits and limitations.
  • Knowledge of growth and development across the life span.
BENEFITS:Benefits:
  • 401(k)
  • Continuing education credits
  • Dental insurance
  • Disability insurance
  • Flexible spending account
  • Health insurance
  • Life insurance

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