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 ...
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 ...
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 ...
Health Care Research Analyst
Boston, MA · On-site
... health insurance utilization, costs and rating, with special emphasis on the small group and ... The Health Care Research Analyst will also review filings made by Third Party Administrators, Risk ...
Health Care Research Analyst
Boston, MA · On-site
... health insurance utilization, costs and rating, with special emphasis on the small group and ... The Health Care Research Analyst will also review filings made by Third Party Administrators, Risk ...
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 ...
Travel Nurse RN - Case Manager, Utilization Review - $2,150 per week
Portsmouth, NH · On-site
$2.1K/wk
Utilization Review * Discipline: RN * Duration: 13 weeks * 36 hours per week * Shift: 12 hours ... Short-term disability, life insurance, paid jury duty * Access to the largest network of facilities ...
New
Travel Nurse RN - Case Manager, Utilization Review - $2,150 per week
Portsmouth, NH · On-site
$2.1K/wk
Utilization Review * Discipline: RN * Duration: 13 weeks * 36 hours per week * Shift: 12 hours ... Short-term disability, life insurance, paid jury duty * Access to the largest network of facilities ...
New
... health insurance utilization, costs and rating, with special emphasis on the small group and ... The Health Care Research Analyst will also review filings made by Third Party Administrators, Risk ...
... health insurance utilization, costs and rating, with special emphasis on the small group and ... The Health Care Research Analyst will also review filings made by Third Party Administrators, Risk ...
... health insurance utilization, costs and rating, with special emphasis on the small group and ... The Health Care Research Analyst will also review filings made by Third Party Administrators, Risk ...
... health insurance utilization, costs and rating, with special emphasis on the small group and ... The Health Care Research Analyst will also review filings made by Third Party Administrators, Risk ...
... evaluation, utilization review, clinical documentation review or a related field is preferred ... Life insurance * 401k * Long-term disability insurance * Paid time off: * Three weeks of vacation ...
Quick apply
... evaluation, utilization review, clinical documentation review or a related field is preferred ... Life insurance * 401k * Long-term disability insurance * Paid time off: * Three weeks of vacation ...
RN Case Manager
Everett, MA · On-site
$2.9K - $3.0K/wk
Case Management/Utilization Review Shift: Day Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License reimbursement for new licenses needed for each assignment
RN Case Manager
Everett, MA · On-site
$2.9K - $3.0K/wk
Case Management/Utilization Review Shift: Day Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License reimbursement for new licenses needed for each assignment
RN - Case Manager
Everett, MA · On-site
$2.9K - $3.0K/wk
Case Management/Utilization Review Shift: Day Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License reimbursement for new licenses needed for each assignment
RN - Case Manager
Everett, MA · On-site
$2.9K - $3.0K/wk
Case Management/Utilization Review Shift: Day Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License reimbursement for new licenses needed for each assignment
RN - Case Manager
Everett, MA · On-site
$2.9K - $3.0K/wk
Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Everett ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...
RN - Case Manager
Everett, MA · On-site
$2.9K - $3.0K/wk
Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Everett ... Benefits: * Day 1 Insurance * Cigna medical, MetLife dental and vision insurance * License ...
... insurance companies to support patient care. This role can be worked remotely from anywhere in the ... utilization management and review. * Participating in monitoring and analyzing Inter-Rater ...
... insurance companies to support patient care. This role can be worked remotely from anywhere in the ... utilization management and review. * Participating in monitoring and analyzing Inter-Rater ...
Nurse Case Manager - Care Transitions (Full Time)
$38.11 - $98.23/hr
The inpatient Case Manager assigned by nursing unit coordinates utilization review, discharge ... all insurance, contractual and regulatory requirements as mandated. 13) Works with Lahey Clinic ...
Nurse Case Manager - Care Transitions (Full Time)
$38.11 - $98.23/hr
The inpatient Case Manager assigned by nursing unit coordinates utilization review, discharge ... all insurance, contractual and regulatory requirements as mandated. 13) Works with Lahey Clinic ...
... review and Utilization Review. This position is 20 hours per week and offers a full benefits package including Health, Dental, Life, & Disability insurance, 403b Savings Plan, Vacation, Sick ...
... review and Utilization Review. This position is 20 hours per week and offers a full benefits package including Health, Dental, Life, & Disability insurance, 403b Savings Plan, Vacation, Sick ...
... utilization reviews to insurers or intermediaries. 6. Identifies SNF and AND days for Medicare and Medicaid patients. 7. Initiates actions concurrently to reduce and/or eliminate inappropriate ...
... utilization reviews to insurers or intermediaries. 6. Identifies SNF and AND days for Medicare and Medicaid patients. 7. Initiates actions concurrently to reduce and/or eliminate inappropriate ...
... utilization reviews to insurers or intermediaries. 6. Identifies SNF and AND days for Medicare and Medicaid patients. 7. Initiates actions concurrently to reduce and/or eliminate inappropriate ...
... utilization reviews to insurers or intermediaries. 6. Identifies SNF and AND days for Medicare and Medicaid patients. 7. Initiates actions concurrently to reduce and/or eliminate inappropriate ...
... utilization reviews to insurers or intermediaries. 6. Identifies SNF and AND days for Medicare and Medicaid patients. 7. Initiates actions concurrently to reduce and/or eliminate inappropriate ...
... utilization reviews to insurers or intermediaries. 6. Identifies SNF and AND days for Medicare and Medicaid patients. 7. Initiates actions concurrently to reduce and/or eliminate inappropriate ...
... utilization reviews to insurers or intermediaries. 6. Identifies SNF and AND days for Medicare and Medicaid patients. 7. Initiates actions concurrently to reduce and/or eliminate inappropriate ...
... utilization reviews to insurers or intermediaries. 6. Identifies SNF and AND days for Medicare and Medicaid patients. 7. Initiates actions concurrently to reduce and/or eliminate inappropriate ...
Insurance Utilization Reviewer information
See Rowley, MA salary details
$33.3K - $34.5K
3% of jobs
$34.5K - $35.8K
14% of jobs
$36.7K is the 25th percentile. Wages below this are outliers.
$35.8K - $37.1K
12% of jobs
$37.1K - $38.3K
12% of jobs
$38.3K - $39.6K
9% of jobs
The median wage is $39.7K / yr.
$39.6K - $40.9K
5% of jobs
$40.9K - $42.1K
0% of jobs
$42.1K - $43.4K
3% of jobs
$43.4K - $44.7K
9% of jobs
$45.1K is the 75th percentile. Wages above this are outliers.
$44.7K - $45.9K
20% of jobs
$45.9K - $47.2K
13% of jobs
$33.3K
$40.8K
$47.2K
How much do insurance utilization reviewer jobs pay per year?
As of Aug 29, 2026, the average yearly pay for insurance utilization reviewer in Rowley, MA is $40,755.00, according to ZipRecruiter salary data. Most workers in this role earn between $36,500.00 and $45,100.00 per year, depending on experience, location, and employer.
What is an insurance utilization reviewer?
Insurance Utilization Reviewers are professionals who evaluate healthcare services to determine if they are medically necessary and covered by insurance policies. They review patient records, treatment plans, and insurance guidelines to ensure that the care provided aligns with established criteria and standards. Their work helps control healthcare costs, prevent unnecessary treatments, and ensure patients receive appropriate care. Utilization reviewers often communicate with healthcare providers and insurance companies to support or deny coverage decisions.
What are the key skills and qualifications needed to thrive as an insurance utilization reviewer, and why are they important?
To thrive as an Insurance Utilization Reviewer, you need a solid understanding of medical terminology, healthcare regulations, and insurance processes, usually supported by a clinical background or relevant certification. Familiarity with utilization review software, electronic health records (EHRs), and coding systems like ICD-10 and CPT is often required. Strong analytical thinking, attention to detail, and effective communication skills help reviewers assess medical necessity and coordinate with healthcare providers. These skills ensure accurate, efficient case evaluations and compliance with policies, which are crucial for optimizing patient care and managing healthcare costs.
What are some common challenges faced by insurance utilization reviewers, and how can they be addressed?
One of the primary challenges Insurance Utilization Reviewers face is balancing the need to adhere to strict insurance guidelines while advocating for appropriate patient care. Reviewers often handle high caseloads and must make timely decisions based on complex medical records, which requires strong attention to detail and up-to-date knowledge of coverage policies. Effective communication with healthcare providers and insurance representatives is also crucial to resolve discrepancies and ensure approvals. Staying organized, continuously updating clinical knowledge, and leveraging support from the utilization review team can help manage these challenges successfully.
What is the difference between Insurance Utilization Reviewer vs Insurance Claims Processor?
| Aspect | Insurance Utilization Reviewer | Insurance Claims Processor |
|---|---|---|
| Primary Role | Review medical necessity and appropriateness of services for insurance coverage | Process and review insurance claims for payment and accuracy |
| Required Credentials | Often requires healthcare or insurance certifications, such as RHIT or CPC | Typically requires claims processing or insurance certifications, like CPC or CPC-H |
| Work Environment | Healthcare settings, insurance companies, or third-party administrators | Insurance companies, healthcare providers, or claims processing centers |
| Industry Usage | Commonly employed in health insurance and managed care | Widely used across health, auto, and property insurance sectors |
The main difference is that Insurance Utilization Reviewers focus on evaluating the medical necessity of services, while Insurance Claims Processors handle the administrative processing of claims. Both roles require insurance-related certifications and are integral to the insurance industry, but they serve distinct functions in the claims and coverage review process.
What job categories do people searching Insurance Utilization Reviewer jobs in Rowley, MA look for?
The top searched job categories for Insurance Utilization Reviewer jobs in Rowley, MA are:
Acadia Healthcare rating
6.2
Based on 190 frontline employees who took The Breakroom Quiz
697th of 895 rated healthcare providers
Job description
PURPOSE STATEMENT:
Proactively monitor utilization of services for patients to optimize reimbursement for the facility.
ESSENTIAL FUNCTIONS:
- Act as liaison between managed care organizations and the facility professional clinical staff.
- Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
- Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
- Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
- Conduct quality reviews for medical necessity and services provided.
- Facilitate peer review calls between facility and external organizations.
- Initiate and complete the formal appeal process for denied admissions or continued stay.
- Assist the admissions department with pre-certifications of care.
- Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.
OTHER FUNCTIONS:
- Perform other functions and tasks as assigned.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
- Required Education: High school diploma or equivalent.
- Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
- Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred
LICENSES/DESIGNATIONS/CERTIFICATIONS:
- Required Licensure: LPN or RN within the state where the facility provides services; or current clinical professional license or certification, as required, within the state where the facility provides services.
- CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
- First aid may be required based on state or facility requirements.
ADDITIONAL REGULATORY REQUIREMENTS:
While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances
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About Acadia Healthcare
Sourced by ZipRecruiter
Acadia Healthcare is a leading provider in the healthcare and hospital industry, based in Franklin, Tennessee, United States. The company is recognised for its commitment to creating a behavioural health network that provides accessible, high-quality treatment options for individuals suffering from mental health issues, addiction, eating disorders, and PTSD. Acadia Healthcare was founded in 2005, with the mission to create a world-class organization that sets the standard of excellence in the treatment of specialty behavioural health and addiction disorders.
Industry
Hospitals
Company size
10,000+ Employees
Headquarters location
Franklin, TN, US
Year founded
2005