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Senior Rn Utilization Review Nurse Jobs in Worcester, MA

Lancesoft INC

Case Management (RN)

Milford, MA · On-site

$3.0K - $3.1K/wk

BSN required Active MA state RN license required 3+ yr of Hospital Case management & Utilization review required BLS (AHA) Covid Card Company Description LanceSoft is rated as one of the largest ...

Lancesoft INC

RN Case Manager

Milford, MA · On-site

$3.0K - $3.1K/wk

BSN required Active MA state RN license required 3+ yr of Hospital Case management & Utilization review required BLS (AHA) Company Description LanceSoft is rated as one of the largest staffing firms ...

TNAA TotalMed RN

Travel Nurse RN - Telemetry

Palmer, MA · On-site

$2.0K - $2.8K/wk

TNAA TotalMed RN is seeking a travel nurse RN Telemetry for a travel nursing job in Palmer, Massachusetts. & Requirements * Specialty: Telemetry * Discipline: RN * Start Date: 08/31/2026 * Duration ...

TNAA TotalMed RN

Travel Nurse RN - Telemetry

Palmer, MA · On-site

$2.0K - $2.8K/wk

TNAA TotalMed RN is seeking a travel nurse RN Telemetry for a travel nursing job in Palmer, Massachusetts. & Requirements * Specialty: Telemetry * Discipline: RN * Duration: 13 weeks * 36 hours per ...

TNAA TotalMed RN

Travel Nurse RN - Telemetry

Worcester, MA · On-site

$2.0K - $2.7K/wk

TNAA TotalMed RN is seeking a travel nurse RN Telemetry for a travel nursing job in Worcester, Massachusetts. & Requirements * Specialty: Telemetry * Discipline: RN * Duration: 13 weeks * 36 hours ...

TNAA TotalMed RN

Travel Nurse RN - Oncology

Milford, MA · On-site

$2.3K - $3.1K/wk

TNAA TotalMed RN is seeking a travel nurse RN Oncology for a travel nursing job in Milford, Massachusetts. & Requirements * Specialty: Oncology * Discipline: RN * Duration: 13 weeks * 36 hours per ...

TNAA TotalMed RN

Travel PICU RN

Worcester, MA · On-site

TNAA TotalMed RN is seeking a travel nurse RN PICU - Pediatric Intensive Care for a travel nursing job in Worcester, Massachusetts. & Requirements * Specialty: PICU - Pediatric Intensive Care

TNAA TotalMed RN

Travel Tele Float RN

Worcester, MA · On-site

$2.0K - $2.7K/wk

TNAA TotalMed RN is seeking a travel nurse RN Float Med Surg for a travel nursing job in Worcester, Massachusetts. & Requirements * Specialty: Float * Discipline: RN * Duration: 13 weeks * 36 hours ...

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Senior Rn Utilization Review Nurse information

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$42

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How much do senior rn utilization review nurse jobs pay per hour?

As of Aug 28, 2026, the average hourly pay for senior rn utilization review nurse in Worcester, MA is $42.19, according to ZipRecruiter salary data. Most workers in this role earn between $33.32 and $48.46 per hour, depending on experience, location, and employer.

What does a Senior RN Utilization Review Nurse do?

A Senior RN Utilization Review Nurse is a registered nurse who evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, apply clinical guidelines, and collaborate with healthcare providers to ensure that treatments are cost-effective and meet established standards of care. Additionally, they often mentor junior staff, participate in policy development, and help optimize resource utilization within healthcare organizations. Their work supports quality patient care while managing healthcare costs.

What are some typical challenges faced by a Senior RN Utilization Review Nurse when coordinating with multidisciplinary teams?

Senior RN Utilization Review Nurses often collaborate with physicians, case managers, and insurance representatives to ensure patients receive appropriate, cost-effective care. A common challenge is balancing clinical guidelines with payer requirements, which can sometimes lead to differing opinions on the necessity of certain treatments or services. Effective communication, strong negotiation skills, and up-to-date knowledge of regulatory standards are essential to navigate these situations successfully. Being proactive and maintaining strong professional relationships helps facilitate smoother approvals and promotes patient-centered care.

What are the key skills and qualifications needed to thrive as a Senior RN Utilization Review Nurse, and why are they important?

To thrive as a Senior RN Utilization Review Nurse, you need a strong clinical nursing background, active RN licensure, and in-depth knowledge of medical necessity criteria and healthcare regulations. Familiarity with utilization review software, electronic health records (EHRs), and certifications like CCM (Certified Case Manager) or URAC are highly beneficial. Exceptional critical thinking, attention to detail, and effective communication skills distinguish top performers in this role. These skills ensure accurate case evaluations, compliance with regulations, and optimized patient care while controlling healthcare costs.

What is the difference between Senior Rn Utilization Review Nurse vs Rn Case Manager?

AspectSenior Rn Utilization Review NurseRn Case Manager
CertificationsRN license, possibly UR or case management certificationRN license, often case management certification
Work EnvironmentHospitals, insurance companies, healthcare organizationsHospitals, community health, insurance providers
Primary FocusReviewing medical necessity and utilization of servicesCoordinating patient care and discharge planning
Common UsageUsed in insurance and healthcare review settingsUsed in patient care coordination and discharge planning

The Senior Rn Utilization Review Nurse primarily focuses on evaluating the necessity and appropriateness of healthcare services, often working within insurance companies or healthcare organizations. In contrast, Rn Case Managers concentrate on coordinating patient care, discharge planning, and ensuring smooth healthcare delivery. Both roles require RN licensure and relevant certifications, but their daily responsibilities and work environments differ slightly.

What are popular job titles related to Senior Rn Utilization Review Nurse jobs in Worcester, MA?

For Senior Rn Utilization Review Nurse jobs in Worcester, MA, the most frequently searched job titles are:

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The top searched job categories for Senior Rn Utilization Review Nurse jobs in Worcester, MA are:

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Cities near Worcester, MA with the most Senior Rn Utilization Review Nurse job openings:

Senior Rn Utilization Review Nurse jobs near you

Concurrent Review RN

Healthcare Support Staffing

Waltham, MA

Full-time

Re-posted 19 days ago

Job description

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Day to Day Duties:


  • This person will be reviewing charts to ensure members are receiving the most appropriate/cost effective care. They will be reviewing the progress of discharge planning to make sure they take appropriate action to keep members out of the hospital. This will be 100% onsite (no travel).
  • Company Job Description:Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews.
  • Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
  • Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
  • Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care
  • Conduct discharge planning
  • Educate providers on utilization and medical management processes
  • Provide clinical knowledge and act as a clinical resource to non-clinical team staff
  • Enter and maintain pertinent clinical information in various medical management systems
  • Direct care to participating network providers
  • Participate in utilization management committees and work on special projects related to utilization management as needed
  • Serve as a subject matter expert for questions or issues for other Concurrent Review Nurses and Prior Authorization Nurses
  • Audit case reviews to ensure compliance with utilization management policies and procedures
  • Assist with the development of utilization management workflows, policies, and procedures
Qualifications

Minimum Education/Licensures/Qualifications:

  • RN licensure
  • associates degree in nursing
  • 3+ years of UM experience in a managed care setting (this is a must)
  • 2+ years of clinical nursing experience

 Shift:

  • 8:00-5:00 100% office Based 


Additional Information

Interested in being considered?

If you are interested in being considered for this position, please click the apply button below.  Or call Ashley Greene 407-478-0332 ext 169

Healthcare Support logo

About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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