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Utilization Review Manager Jobs in Boston, MA (NOW HIRING)

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

The ideal candidate will have a strong background in managed care, utilization management, medical necessity review, prior authorization, and outpatient clinical review. This role is responsible for ...

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Utilization Review Manager information

See Boston, MA salary details

$42.4K

$98.9K

$182K

How much do utilization review manager jobs pay per year?

As of Aug 20, 2026, the average yearly pay for utilization review manager in Boston, MA is $98,870.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,600.00 and $119,000.00 per year, depending on experience, location, and employer.

What does a utilization review manager do?

A Utilization Review Manager oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They ensure that patient care adheres to established guidelines and that healthcare resources are used effectively. Their duties typically include leading a team of reviewers, collaborating with healthcare providers, ensuring compliance with regulations, and making recommendations on care authorization. The goal is to balance quality patient care with cost-effective resource management.

What are the key skills and qualifications needed to thrive as a utilization review manager?

To thrive as a Utilization Review Manager, you need a solid background in healthcare management, clinical knowledge (often as an RN or healthcare professional), and experience with utilization review processes. Familiarity with case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Certified Professional in Utilization Review (CPUR) are often expected. Strong analytical thinking, attention to detail, leadership, and effective communication are crucial soft skills for success in this role. These skills ensure appropriate resource use, regulatory compliance, and coordinated patient care, which are vital for both healthcare quality and operational efficiency.

What are some common challenges faced by utilization review managers in balancing patient care and cost efficiency?

Utilization Review Managers often encounter the challenge of ensuring patients receive appropriate care while also adhering to insurance and regulatory guidelines that emphasize cost efficiency. This requires strong analytical skills to assess clinical information and make fair determinations, often under tight deadlines and with incomplete data. The role also involves frequent communication with physicians, payers, and case managers to resolve disagreements and clarify criteria, making negotiation and diplomacy essential. Staying updated on changing healthcare regulations and payer requirements can add to the complexity, but it also provides opportunities for professional growth and leadership within healthcare administration.

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

AspectUtilization Review ManagerUtilization Review Coordinator
CertificationsTypically requires certifications like CCM or ACUMay require similar certifications but often less advanced
Work EnvironmentSupervises review teams, manages processes in healthcare or insurance settingsPerforms case reviews, supports the review process under supervision
Employer & IndustryHospitals, insurance companies, healthcare organizationsInsurance companies, healthcare providers, third-party administrators

The Utilization Review Manager oversees review teams and manages utilization review processes, focusing on policy compliance and efficiency. The Utilization Review Coordinator supports the review process by conducting case assessments and assisting managers. While both roles require similar certifications and work in related environments, the manager holds a supervisory position with broader responsibilities.

How much does a utilization review manager make?

A utilization review manager typically earns between $70,000 and $110,000 annually, depending on experience, location, and the size of the organization. They often require knowledge of healthcare policies, insurance processes, and may hold certifications such as URAC or CCM.

Is utilization review manager a stressful job?

Utilization review managers often work in a fast-paced healthcare environment, which can be stressful due to the need to meet strict deadlines, ensure accurate assessments, and handle complex cases. The role requires strong organizational skills and attention to detail, and some individuals may find the responsibility and workload challenging, especially during high-volume periods.

What are the most commonly searched types of Utilization Review jobs in Boston, MA?

The most popular types of Utilization Review jobs in Boston, MA are:

What are popular job titles related to Utilization Review Manager jobs in Boston, MA?

For Utilization Review Manager jobs in Boston, MA, the most frequently searched job titles are:

What job categories do people searching Utilization Review Manager jobs in Boston, MA look for?

The top searched job categories for Utilization Review Manager jobs in Boston, MA are:

What cities near Boston, MA are hiring for Utilization Review Manager jobs?

Cities near Boston, MA with the most Utilization Review Manager job openings:

Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Boston, MA as of August 2026, with employment types broken down into 85% Full Time, 12% Part Time, and 3% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $98,870 per year, or $47.5 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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