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Utilization Review Coordinator Jobs in Roxbury, MA

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Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

Ensure all utilization review activities meet regulatory turnaround time requirements. * Collaborate with Medical Directors for complex cases, denial recommendations, and clinical escalations.

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Utilization Review Coordinator information

See Roxbury, MA salary details

$17

$32

$50

How much do utilization review coordinator jobs pay per hour?

As of Aug 20, 2026, the average hourly pay for utilization review coordinator in Roxbury, MA is $32.13, according to ZipRecruiter salary data. Most workers in this role earn between $23.22 and $37.55 per hour, depending on experience, location, and employer.

What does a utilization review coordinator do?

A Utilization Review Coordinator is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance information to ensure that care meets established guidelines and regulatory requirements. By coordinating between healthcare providers, insurance companies, and patients, Utilization Review Coordinators help optimize resource use and manage healthcare costs while ensuring quality patient care.

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

To thrive as a Utilization Review Coordinator, you need expertise in healthcare regulations, clinical guidelines, and case management, often supported by an RN license or a background in health administration. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance approval processes are typically required. Strong analytical thinking, attention to detail, and effective communication skills help you collaborate with providers and advocate for appropriate patient care. These skills ensure compliance, optimize resource use, and support quality care delivery within healthcare organizations.

How does a utilization review coordinator collaborate with healthcare providers and insurance companies?

A Utilization Review Coordinator regularly communicates with both healthcare providers and insurance companies to ensure that patients receive appropriate care while managing costs. They review medical records and treatment plans, discuss cases with physicians to clarify medical necessity, and submit documentation to insurance payers for approval. This role requires strong interpersonal skills, as coordinators often need to negotiate coverage decisions and resolve discrepancies between clinical teams and insurers. Effective collaboration ensures timely authorizations and helps avoid unnecessary delays in patient care.

What is the difference between Utilization Review Coordinator vs Utilization Review Nurse?

AspectUtilization Review CoordinatorUtilization Review Nurse
CredentialsTypically requires a healthcare-related certification or associate degreeRegistered Nurse (RN) license required
Work EnvironmentOffice setting, administrative tasks, coordinationClinical setting, patient chart review, direct communication with healthcare providers
Employer & IndustryInsurance companies, healthcare organizationsHospitals, insurance companies, healthcare providers
Common Search & ComparisonFocuses on administrative review processesInvolves clinical assessment and patient care considerations

While both roles involve reviewing healthcare utilization, the Utilization Review Coordinator primarily handles administrative and coordination tasks, often without direct patient contact, whereas the Utilization Review Nurse performs clinical assessments as a licensed RN, often in hospital or clinical settings. Understanding these differences helps job seekers identify the right role based on their credentials and career goals.

What cities near Roxbury, MA are hiring for Utilization Review Coordinator jobs?

Cities near Roxbury, MA with the most Utilization Review Coordinator job openings:

Utilization Review Coordinator jobs near you
Infographic showing various Utilization Review Coordinator job openings in Roxbury, MA as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $66,835 per year, or $32.1 per hour.

Utilization Review Coordinator

Emerson Hospital

Concord, MA • On-site

$45 - $65/hr

Full-time

Posted 2 days ago

New

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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