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Utilization Review Assistant Jobs in Massachusetts

Gosnold

Assistant Director of CSS

West Falmouth, MA · On-site

$95K - $105K/yr

The Assistant Director of CSS oversees clinical reviews to monitor patient progress while ... Participate in utilization review activities in conjunction with other departments to ensure that ...

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How much do utilization review assistant jobs pay per hour?

As of Aug 11, 2026, the average hourly pay for utilization review assistant in Massachusetts is $33.20, according to ZipRecruiter salary data. Most workers in this role earn between $18.82 and $40.74 per hour, depending on experience, location, and employer.

What is a utilization review assistant?

A Utilization Review Assistant supports the utilization review process by reviewing medical records, verifying insurance coverage, and ensuring that healthcare services meet necessary guidelines. They assist in gathering documentation, communicating with insurance providers, and coordinating with medical staff to facilitate approvals for treatments. Their role helps ensure that healthcare services are provided efficiently while maintaining compliance with insurance policies and regulations.

What skills and qualifications are needed to be a utilization review assistant?

To thrive as a Utilization Review Assistant, you need attention to detail, basic understanding of medical terminology, strong organizational skills, and typically a high school diploma or equivalent. Familiarity with healthcare management software and electronic health records (EHR) systems, along with experience in data entry, is important for this role. Strong communication, problem-solving abilities, and a customer service-oriented attitude help you excel when interacting with clinical staff and patients. These skills are essential for ensuring accurate review processes, compliance with regulations, and effective coordination within healthcare teams.

What does a utilization review assistant do?

A Utilization Review Assistant typically spends their day reviewing medical records, verifying patient information, and ensuring documentation meets insurance or regulatory requirements. They often work closely with nurses, physicians, case managers, and billing staff to collect necessary data and clarify documentation. The work is usually performed in an office within a hospital, clinic, or insurance company, where prioritizing tasks and maintaining confidentiality are key. This collaborative, detail-oriented environment provides a valuable introduction to healthcare administration and can open doors to broader roles in utilization management or case management.

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 Utilization Review Assistant jobs in Massachusetts? For Utilization Review Assistant jobs in Massachusetts, the most frequently searched job titles are:
What job categories do people searching Utilization Review Assistant jobs in Massachusetts look for? The top searched job categories for Utilization Review Assistant jobs in Massachusetts are:
What cities in Massachusetts are hiring for Utilization Review Assistant jobs? Cities in Massachusetts with the most Utilization Review Assistant job openings:
Utilization Review Assistant jobs near you
Infographic showing various Utilization Review Assistant job openings in Massachusetts as of August 2026, with employment types broken down into 1% As Needed, 85% Full Time, 12% Part Time, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $69,051 per year, or $33.2 per hour.

Utilization Review Specialist - VNA

Berkshire Health Systems

Pittsfield, MA • On-site

$40.54/hr

Part-time

Re-posted 23 days ago

Berkshire Health Systems rating

8.2

Company rating: 8.2 out of 10

Based on 19 frontline employees who took The Breakroom Quiz

Job description

  • DEFINITION/PRIMARY FUNCTIONS
    • The Utilization Program Specialist is responsible for evaluating the necessity and appropriateness of services to ensure that they are effective and cost efficient. The Utilization Program Specialist works in tandem with the Clinical Manager to assist the clinical staff with case management and ensure care is delivered according to BVNA standards/pathways and regulatory requirements. He/she provides direction and acts as a resource for Clinical Managers and staff regarding reimbursement. The Utilization Program Specialist organizes, complies and translates medical information into medical codes according to home care coding conventions.
  • POSITION QUALIFICATIONS (Minimum qualifications are required unless stated otherwise.)
    • Experience:
      • Minimum of 3 years of work experience in a certified home health agency. Experience with quality assurance or utilization review preferred.
      • Knowledge of current regulations governing third party reimbursement for home health required.
      • Ability to cooperate, guide and instruct a multi-disciplinary team required.
      • Ability to exercise independent judgement; demonstrated time management skills; demonstrated ability to facilitate smooth flow of home care patients.
      • Demonstrated ability to conform with Service Excellence Standards
      • Demonstrated knowledge of Conditions of Participation in home care.
      • Demonstrated general computer skills required. Demonstrated knowledge of Windows, including Microsoft Word, Excel and E-mail preferred.
    • Education and Training:
      • BSN nursing strongly preferred.
      • Certification in Current version of Home Health coding required.
    • License, Certification & Registration:
      • RN - Currently licensed as an RN in the state of Massachusetts
      • OACSHC - Certification in Outcome and Assessment Information Set (OASIS) as a COS-C- OASIS Specialist-Clinical or HCS-O- Home Care Clinical Specialist.
      • DRIVER - Driver's License
    • Other Requirements:
      • Ability to maintain confidentiality.
      • Ability to be flexible regarding work hours.
      • Knowledge of community resources.
      • Demonstrated problem-solving ability.

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