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Precertification Jobs in Massachusetts (NOW HIRING)

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

Perform outpatient utilization management (UM) and medical necessity reviews for prior authorization and precertification requests. * Review clinical documentation and determine benefit eligibility ...

Amedisys, Inc.

Clinical Manager

Plymouth, MA · On-site

$100K - $115K/yr

  • Medical

  • Retirement

  • PTO

Oversees payor verification and precertification requirements. * Reviews documentation of other staff members and ensures missing, incomplete and/or untimely documentation issues are resolved.

Amedisys, Inc.

Clinical Manager

Marlborough, MA · On-site

$106K - $120K/yr

  • Medical

  • Retirement

  • PTO

Oversees payor verification and precertification requirements. * Reviews documentation of other staff members and ensures missing, incomplete and/or untimely documentation issues are resolved.

Amedisys, Inc.

RN Clinical Manager Hospice

Fall River, MA · On-site

$105K/yr

  • Medical

  • Retirement

  • PTO

Oversees payor verification and precertification requirements. * Reviews documentation of other staff members and ensures missing, incomplete and/or untimely documentation issues are resolved.

Sturdy Health

Insurance Authorization Representative

Attleboro, MA · On-site

$41K - $56K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

Obtain precertification/authorization for inpatient and observation patients presenting through the Emergency Department. * Run payer eligibility, review self-pay and refer to Financial Counselors as ...

Amedisys, Inc.

Clinical Manager

Marlborough, MA · On-site

$106K - $120K/yr

  • Medical

  • Retirement

  • PTO

Oversees payor verification and precertification requirements. * Reviews documentation of other staff members and ensures missing, incomplete and/or untimely documentation issues are resolved.

Amedisys, Inc.

Clinical Manager

Plymouth, MA

$100K - $115K/yr

  • Medical

  • Retirement

  • PTO

Oversees payor verification and precertification requirements. * Reviews documentation of other staff members and ensures missing, incomplete and/or untimely documentation issues are resolved.

Amedisys, Inc.

RN Clinical Manager Hospice

Fall River, MA

$105K - $110K/yr

  • Medical

  • Retirement

  • PTO

Oversees payor verification and precertification requirements. * Reviews documentation of other staff members and ensures missing, incomplete and/or untimely documentation issues are resolved.

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Showing results 1-20

All JobsPrecertification JobsPrecertification Jobs in Massachusetts

Precertification information

What is a precertification specialist?

Precertification jobs involve reviewing and approving medical procedures, treatments, or hospital admissions before they occur to ensure they meet insurance or regulatory requirements. Professionals in these roles typically evaluate patient information, communicate with healthcare providers, and coordinate with insurance companies to determine if services will be covered. This process helps control healthcare costs and ensures that patients receive appropriate care according to established guidelines. Precertification specialists often work in hospitals, insurance companies, or healthcare administration settings.

What skills and qualifications are needed to thrive as a precertification specialist?

Success as a precertification specialist requires knowledge of medical terminology, insurance verification, and healthcare regulations, often supported by a background in healthcare administration or certification such as Certified Medical Administrative Assistant (CMAA). Familiarity with insurance portals, electronic health record (EHR) systems, and payer-specific software is typically necessary. Attention to detail, strong organizational skills, and effective communication are vital soft skills that help in coordinating between providers, patients, and insurers. These abilities ensure accurate and timely approval of medical procedures, reducing delays in patient care and minimizing claim denials.

What are common challenges faced by precertification specialists, and how can they be addressed?

Precertification Specialists often face challenges such as staying up-to-date with constantly changing insurance guidelines, managing high volumes of requests, and communicating effectively with both healthcare providers and insurance representatives. To address these, it is important to maintain strong organizational skills, leverage available technology for tracking authorizations, and participate in ongoing training to remain current on payer requirements. Building good relationships with team members and regularly sharing updates can also help streamline processes and minimize delays.

What is the difference between Precertification vs Medical Coder?

AspectPrecertificationMedical Coder
Required credentialsCertification may be preferred; knowledge of insurance policiesCertification (e.g., CPC, CCS) often required
Work environmentHealthcare facilities, insurance companies, outpatient clinicsHospitals, clinics, insurance companies, remote work
Employer usageUsed to approve procedures before serviceUsed to assign codes for billing and documentation
Common search intentPrecertification vs Medical Coder

Precertification involves obtaining approval from insurance companies before procedures, focusing on insurance policies and patient eligibility. Medical coders assign standardized codes to medical records for billing, emphasizing coding accuracy and documentation. While both roles are integral to healthcare billing, precertification is about approval processes, whereas medical coding centers on documentation and coding accuracy.

What are the most commonly searched types of Precertification jobs in Massachusetts?

The most popular types of Precertification jobs in Massachusetts are:

What are popular job titles related to Precertification jobs in Massachusetts?

For Precertification jobs in Massachusetts, the most frequently searched job titles are:

What job categories do people searching Precertification jobs in Massachusetts look for?

The top searched job categories for Precertification jobs in Massachusetts are:

Precertification jobs near you
Infographic showing various Precertification job openings in Massachusetts as of August 2026, with employment types broken down into 5% As Needed, 82% Full Time, 12% Part Time, and 1% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution.

Utilization Review Nurse

US Tech Solutions

Canton, MA • On-site

$55 - $60/hr

Other

Posted 9 days ago

Job description

$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:

  • Candidates can be remote but must have an active unrestricted Massachusetts RN License

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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About US Tech Solutions

Sourced by ZipRecruiter

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Jersey City, NJ, US

Year founded

2000

Social media

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