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Remote Utilization Review Jobs in Massachusetts (NOW HIRING)

Brown & Brown Insurance

Consultant

Southborough, MA · On-site +1

$100K - $125K/yr

This role offers flexibility with remote or hybrid work options. As a Consultant, you will manage ... Analyze data and financial metrics , conduct utilization reviews, and perform peer audits to ...

Cytel

Associate Director, Project Finance

Cambridge, MA · On-site +1

This remote role requires someone who can operate autonomously, influence without authority, and ... Prepare executive-level reporting and presentations for leadership review. * Translate complex ...

UnitedHealth Group

Patient Care Coordinator

Worcester, MA · On-site +1

$17.50 - $23/hr

Reviews and facilitates the updating of missing /outdated information in the patient record with ... Ability to work collaboratively with interdisciplinary teams consisting of remote and onsite staff ...

Owl Labs

Senior Linux Device Programmer

Boston, MA · On-site +1

$170K - $185K/yr

Mentor junior engineers and review code contributions QUALIFICATIONS EDUCATION * Bachelor's degree ... This role can be remote or hybrid. Salary Range $170,000--$185,000 USD Owl Labs is an Equal ...

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Remote Utilization Review information

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$23

$46

$75

How much do remote utilization review jobs pay per hour?

As of Aug 24, 2026, the average hourly pay for remote 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 a remote utilization review?

A Remote Utilization Review job involves assessing medical records and treatment plans to ensure they meet insurance guidelines and medical necessity criteria. Professionals in this role, often nurses or healthcare specialists, work remotely to review patient care for cost-effectiveness and compliance with policies. They collaborate with healthcare providers, insurance companies, and case managers to approve or deny services based on established guidelines. This position requires strong analytical skills, knowledge of medical policies, and attention to detail.

What does a remote utilization review do?

A typical day for a Remote Utilization Review professional involves reviewing patient medical records, evaluating the necessity of proposed treatments against established guidelines, and collaborating with healthcare providers to gather additional information when needed. You will spend much of your time analyzing documentation, submitting recommendations, and ensuring that care authorization decisions align with payer policies and clinical best practices. Communication with case managers, physicians, and insurance representatives is frequent and essential. The work is generally independent and deadline-driven but requires strong teamwork and responsiveness through virtual meetings, emails, and calls.

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

To thrive as a Remote Utilization Review professional, you need a solid foundation in clinical knowledge, critical thinking, and an active RN or LPN license, often supported by experience in case management or prior authorization. Familiarity with medical coding (ICD-10, CPT), electronic health records (EHRs), and utilization management software is typically required, along with URAC or related certifications. Excellent communication, attention to detail, and strong organizational skills help you efficiently manage cases and coordinate with providers and payers. These skills ensure accurate assessments of medical necessity, compliance with regulations, and effective remote collaboration with healthcare teams.

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

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

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

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

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

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

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

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

Remote Utilization Review jobs near you
Infographic showing various Remote Utilization Review job openings in Massachusetts as of August 2026, with employment types broken down into 1% As Needed, 86% Full Time, 10% Part Time, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $96,048 per year, or $46.2 per hour.

Senior Medical Director, Health Plan

Massgeneralbrigham

Somerville, MA • Remote

Full-time

Posted 19 days ago

Job description

Site: Mass General Brigham Health Plan Holding Company, Inc.


Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.


Job Summary

The Senior Medical Director serves as a key clinical executive within the health plan, providing strategic leadership, medical oversight, and clinical expertise to ensure highquality, costeffective care for members. This role partners closely with executive leadership, clinical operations, network management, quality, and compliance teams to shape clinical strategy, guide utilization management, and support valuebased care initiatives. The Senior Medical Director represents the health plan externally with providers, regulators, and community partners.
Does this position require Patient Care?
Yes


Qualifications

Essential Function:

  • Develop and execute clinical strategies that improve member outcomes, reduce unnecessary utilization, and support organizational goals and provide medical expertise to guide benefit design, population health programs, and valuebased care models.
  • Serve as a clinical advisor to senior executives and crossfunctional teams.
  • Oversee utilization management (UM) programs, ensuring evidencebased, timely, and compliant decisionmaking.
  • Review complex or escalated cases, appeals, and grievances, and ensure UM policies align with regulatory requirements, accreditation standards, and clinical best practices.
  • Lead quality improvement initiatives, including HEDIS, Stars, NCQA, and other performance programs, and partner with analytics teams to identify trends in utilization, quality, and member health outcomes.
  • Support the development of population health programs targeting chronic disease management, behavioral health, and social determinants of health.
  • Collaborate with provider network teams to improve clinical performance, reduce variation, and support valuebased contracting, and engage with physicians and health systems to promote evidencebased care and address performance issues.
  • Represent the health plan in provider forums, committees, and external meetings.
  • Ensure clinical programs comply with federal and state regulations, accreditation standards, and internal policies, and participate in audits, regulatory reviews, and accreditation activities.
  • Maintain uptodate knowledge of evolving healthcare regulations and clinical guidelines.
  • Partner with behavioral health, pharmacy, care management, and social care teams to coordinate integrated care strategies.
  • Provide medical leadership for product development, member engagement initiatives, and clinical innovation projects, and support executive leadership with clinical insights for strategic planning and organizational decisionmaking.

Education:
Doctorate Related Field of Study required
Can this role accept experience in lieu of a degree?
No
Licenses and Credentials
Physician License. Must hold or be able to obtain a full active Massachusetts physician license.

Must have 3-5 years of Health Plan experience

  • Must have prior experience in utilization management, peer to peer discussions


Experience:
Clinical Experience 8-10+ years required and Experience in managed care, health plan, or population health leadership role 5-7 years required
Knowledge, Skills and Abilities:

  • Strategic thinking and clinical judgment
  • Executive communication and influence
  • Datadriven decisionmaking
  • Collaborative leadership
  • Regulatory and compliance awareness
  • Provider engagement and relationshipbuilding

Salary Range:

$320 - $350K (depending upon experience)


Additional Job Details (if applicable)


Remote Type

Remote


Work Location

399 Revolution Drive


Scheduled Weekly Hours

40


Employee Type

Regular


Work Shift

Day (United States of America)


EEO Statement:

8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.


Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

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