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Utilization Review Case Manager Jobs in Groton, MA

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

Bachelor's degree. - Preferred * 5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review. * Five years clinical ...

Merrimack Health

Utilization Review Nurse

Lawrence, MA · On-site

Bachelor's degree. - Preferred * 5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review. * Five years clinical ...

Merrimack Health

Utilization Review Nurse

Methuen, MA · On-site

Bachelor's degree. - Preferred * 5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review. * Five years clinical ...

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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 31, 2026, the average hourly pay for utilization review case manager in Groton, MA is $39.96, according to ZipRecruiter salary data. Most workers in this role earn between $32.40 and $42.12 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 cities near Groton, MA are hiring for Utilization Review Case Manager jobs?

Cities near Groton, MA 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 Groton, MA as of August 2026, with employment types broken down into 69% Full Time, and 31% Part Time. Highlights an 85% In-person, and 15% Hybrid job distribution, with an average salary of $83,114 per year, or $40 per hour.

Utilization Review Nurse

Methuen, MA • On-site

Merrimack Health
See more jobs at Merrimack Healthexternal

Full-time

Posted 4 days ago

Job description

Position Summary
Responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for continued stay. Responsible for working with the Clinical Care Coordinator and Complex Care Manager to facilitate timely discharge, assure medical documentation accurately reflects the patient's severity of illness; and ensures compliance with the conditions of participation as they relate to utilization review and discharge planning and payer regulations.
MINIMUM EDUCATION AND EXPERIENCE:
Required:
  • Graduate of an accredited professional nursing school
  • Current Massachusetts Nursing license
  • Bachelor's degree. - Preferred
  • 5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review.
  • Five years clinical nursing experience
  • Demonstrated verbal, written skills
  • Computer skills

Preferred:
  • Master's degree.

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