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Utilization Review Case Manager Jobs in Massachusetts

Emerson Hospital

Utilization Review Coordinator

Concord, MA · On-site

$45 - $65/hr

The Utilization review coordinator's primary responsibility is to monitor adherence to the hospital ... Education: RN licensure required, BSN preferred Experience: 3years hospital case management or ...

New

Emerson Hospital

Utilization Review Coordinator

Concord, MA · On-site

$45 - $65/hr

The Utilization review coordinator's primary responsibility is to monitor adherence to the hospital ... Education: RN licensure required, BSN preferred Experience: 3years hospital case management or ...

New

Emerson Hospital

Utilization Review Coordinator

Concord, MA · On-site

$45 - $65/hr

The Utilization review coordinator's primary responsibility is to monitor adherence to the hospital ... Education: RN licensure required, BSN preferred Experience: 3years hospital case management or ...

New

Emerson Hospital

Utilization Review Coordinator

Concord, MA · On-site

$45 - $65/hr

The Utilization review coordinator's primary responsibility is to monitor adherence to the hospital ... Education: RN licensure required, BSN preferred Experience: 3years hospital case management or ...

New

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

Minimum 3-5 years of Utilization Management (UM), Case Management, Prior Authorization, or Medical ... Experience reviewing outpatient clinical services. * Excellent clinical assessment and critical ...

Lifepoint Health

Specialist, Utilization Review

Holyoke, MA · On-site

$33.22 - $44.85/hr

Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued ... UR contacts external case managers/managed care organizations for certification of insurance ...

Lifepoint Health

Specialist, Utilization Review

Holyoke, MA · On-site

$33.22 - $44.85/hr

Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued ... UR contacts external case managers/managed care organizations for certification of insurance ...

Lifepoint Health

Specialist, Utilization Review

Holyoke, MA · On-site

$33.22 - $44.85/hr

Utilization Review Specialist facilitates clinical reviews on all patient admissions and continued ... UR contacts external case managers/managed care organizations for certification of insurance ...

American Traveler

Travel RN Case Manager

Boston, MA · On-site

Travel RN - Case Management/Utilization Review - Case Management About American Traveler With over 25 years of experience, American Traveler has established a reputation for outstanding customer ...

Mission Hospital

RN - Case Manager

Springfield, MA · On-site

$2.0K/wk

Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with ...

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Utilization Review Case Manager information

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How much do utilization review case manager jobs pay per hour?

As of Aug 20, 2026, the average hourly pay for utilization review case manager in Massachusetts is $39.85, according to ZipRecruiter salary data. Most workers in this role earn between $32.31 and $42.02 per hour, depending on experience, location, and employer.

What is a utilization review case manager?

A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.

What are some common challenges utilization review case managers face when coordinating care across multiple departments?

Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.

What are the key skills and qualifications needed to thrive as a utilization review case manager, and why are they important?

To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.

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

AspectUtilization Review Case ManagerUtilization Review Nurse
CredentialsTypically requires a nursing license or relevant healthcare certificationRegistered Nurse (RN) license is required
Work EnvironmentOffice-based, insurance companies, healthcare organizationsHospital, clinic, insurance review departments
Primary FocusReviewing medical necessity, coordinating care, managing casesAssessing medical records, clinical review, patient care evaluation

Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.

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

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

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

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

What cities in Massachusetts are hiring for Utilization Review Case Manager jobs?

Cities in Massachusetts with the most Utilization Review Case Manager job openings:

Utilization Review Case Manager jobs near you
Infographic showing various Utilization Review Case Manager job openings in Massachusetts as of August 2026, with employment types broken down into 60% Full Time, and 40% Contract. Highlights an 100% In-person job distribution, with an average salary of $82,882 per year, or $39.8 per hour.

Utilization Review Coordinator

Emerson Hospital

Concord, MA • On-site

$45 - $65/hr

Full-time

This job post has expired today. Applications are no longer accepted.

Emerson Hospital rating

8.2

Company rating: 8.2 out of 10

Based on 19 frontline employees who took The Breakroom Quiz

100th of 1,060 rated hospitals

Job description

Job Summary:
The Utilization review coordinator's primary responsibility is to monitor adherence to the hospital's utilization review plan to ensure the effective and efficient use of hospital services. The coordinator will ensure that all patients admitted to EH are appropriate for admission to the hospital and are at the correct level of care. They will ensure that clinical reviews are given to the payer care manager in a timely manner and that potential denials in care are addressed concurrently to prevent retrospective denials. This will involve communication and collaboration with payer care managers to understand their clinical criteria, appeal process and collaboration while patient is in house to prevent or minimize retrospective denials.
Requirements:
Education: RN licensure required, BSN preferred
Experience: 3years hospital case management or utilization management experience

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