Bachelor's degree required. * 5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review. * Five years clinical ...
Bachelor's degree required. * 5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review. * Five years clinical ...
Registered Nurse, MDS (FT & PT)
Boston, MA · On-site
PTO
Document assessments in the health plan's care management platform (GuidingCare) following the ... review and audit. * Complete required training and ongoing training to nd maintain system access.
Registered Nurse, MDS (FT & PT)
Boston, MA · On-site
PTO
Document assessments in the health plan's care management platform (GuidingCare) following the ... review and audit. * Complete required training and ongoing training to nd maintain system access.
Case Manager RN
Portsmouth, NH · On-site
Medical
Dental
Vision
Life
Retirement
PTO
Performs utilization review ensuring admissions meet criteria for appropriateness of care and medical necessity * Manages the process to review and, as appropriate, appeal denials received from ...
Case Manager RN
Portsmouth, NH · On-site
Medical
Dental
Vision
Life
Retirement
PTO
Performs utilization review ensuring admissions meet criteria for appropriateness of care and medical necessity * Manages the process to review and, as appropriate, appeal denials received from ...
Manager, Scheduling and Utilization
Burlington, MA · On-site
$127 - $140/hr
Manager, Scheduling and Utilization Burlington, MA, US 4 days ago Requisition ID: 1336 Position ... Conduct annual performance reviews and provide regular feedback based on goals. * Organize the ...
Manager, Scheduling and Utilization
Burlington, MA · On-site
$127 - $140/hr
Manager, Scheduling and Utilization Burlington, MA, US 4 days ago Requisition ID: 1336 Position ... Conduct annual performance reviews and provide regular feedback based on goals. * Organize the ...
... management, and utilization review preferred. • Strong verbal and written communications skills • Proficiency with computers and an ability to learn new programs with ease.
... management, and utilization review preferred. • Strong verbal and written communications skills • Proficiency with computers and an ability to learn new programs with ease.
... management, and utilization review preferred. Strong verbal and written communications skills Proficiency with computers and an ability to learn new programs with ease.
... management, and utilization review preferred. Strong verbal and written communications skills Proficiency with computers and an ability to learn new programs with ease.
Minimum 5 years clinical nursing experience ? 5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review preferred.
Minimum 5 years clinical nursing experience ? 5 years case management experience in an acute care setting with discharge planning, continuing care, care management, and utilization review preferred.
... management, and utilization review preferred. Strong verbal and written communications skills Proficiency with computers and an ability to learn new programs with ease.
... management, and utilization review preferred. Strong verbal and written communications skills Proficiency with computers and an ability to learn new programs with ease.
SCO RN UM Reviewer
East Boston, MA · On-site
$44/hr
The Utilization Management Review Nurse has a key role in ensuring CCA meets CMS compliance standards in the area of service decisions and organizational determinations. This position requires ...
SCO RN UM Reviewer
East Boston, MA · On-site
$44/hr
The Utilization Management Review Nurse has a key role in ensuring CCA meets CMS compliance standards in the area of service decisions and organizational determinations. This position requires ...
SCO RN UM Reviewer
East Boston, MA · On-site
Medical
Dental
Life
Retirement
The Utilization Management Review Nurse has a key role in ensuring CCA meets CMS compliance standards in the area of service decisions and organizational determinations. This position requires ...
SCO RN UM Reviewer
East Boston, MA · On-site
Medical
Dental
Life
Retirement
The Utilization Management Review Nurse has a key role in ensuring CCA meets CMS compliance standards in the area of service decisions and organizational determinations. This position requires ...
Nurse Case Manager - Care Transitions (Full Time)
Burlington, MA · On-site
$38.11 - $98.23/hr
Essential Duties & Responsibilities including but not limited to: 1) Performs utilization review ... Two years of case management or utilization management experience desirable. • Demonstrated ...
Nurse Case Manager - Care Transitions (Full Time)
Burlington, MA · On-site
$38.11 - $98.23/hr
Essential Duties & Responsibilities including but not limited to: 1) Performs utilization review ... Two years of case management or utilization management experience desirable. • Demonstrated ...
Nurse Case Manager - Care Transitions (Part Time)
Burlington, MA · On-site
$38.11 - $98.23/hr
Essential Duties & Responsibilities including but not limited to: 1) Performs utilization review ... Two years of case management or utilization management experience desirable. • Demonstrated ...
Nurse Case Manager - Care Transitions (Part Time)
Burlington, MA · On-site
$38.11 - $98.23/hr
Essential Duties & Responsibilities including but not limited to: 1) Performs utilization review ... Two years of case management or utilization management experience desirable. • Demonstrated ...
Nurse Case Manager - Care Transitions (Part Time)
$38.11 - $98.23/hr
Essential Duties & Responsibilities including but not limited to: 1) Performs utilization review ... Two years of case management or utilization management experience desirable. • Demonstrated ...
Nurse Case Manager - Care Transitions (Part Time)
$38.11 - $98.23/hr
Essential Duties & Responsibilities including but not limited to: 1) Performs utilization review ... Two years of case management or utilization management experience desirable. • Demonstrated ...
Case Manager - Care Transitions (Part Time., Weekdays)
Burlington, MA · On-site
$38.11 - $98.23/hr
Essential Duties & Responsibilities including but not limited to: 1) Performs utilization review ... Two years of case management or utilization management experience desirable. • Demonstrated ...
Case Manager - Care Transitions (Part Time., Weekdays)
Burlington, MA · On-site
$38.11 - $98.23/hr
Essential Duties & Responsibilities including but not limited to: 1) Performs utilization review ... Two years of case management or utilization management experience desirable. • Demonstrated ...
Senior Solution Advisor, Payment Integrity
$148K - $148K/yr
Medical
Dental
Vision
Life
Retirement
PTO
Prior experience in healthcare Payment Integrity/Case Management required (ex., clinical and coding bill review/audits, utilization review/management, prior authorizations, disputes/appeals). Coding ...
Senior Solution Advisor, Payment Integrity
$148K - $148K/yr
Medical
Dental
Vision
Life
Retirement
PTO
Prior experience in healthcare Payment Integrity/Case Management required (ex., clinical and coding bill review/audits, utilization review/management, prior authorizations, disputes/appeals). Coding ...
Team Medical Director- OB
Lynn, MA · On-site
$120K - $250K/yr
Medical
Dental
Vision
Retirement
Are you able to meet with practice managers and providers to improve health outcomes and positive ... Experience in Quality Assurance, Utilization Review, Continuous Quality Improvement preferred.
Quick apply
Team Medical Director- OB
Lynn, MA · On-site
$120K - $250K/yr
Medical
Dental
Vision
Retirement
Are you able to meet with practice managers and providers to improve health outcomes and positive ... Experience in Quality Assurance, Utilization Review, Continuous Quality Improvement preferred.
Case Manager
Woburn, MA · On-site
$45 - $53/hr
Medical
Dental
Vision
Retirement
PTO
Case Manager Full-Time | Monday-Friday | Rotating Weekends Make a Meaningful Impact Every Day Are ... Support utilization review and quality improvement initiatives Qualifications * Active RN, Social ...
Quick apply
Case Manager
Woburn, MA · On-site
$45 - $53/hr
Medical
Dental
Vision
Retirement
PTO
Case Manager Full-Time | Monday-Friday | Rotating Weekends Make a Meaningful Impact Every Day Are ... Support utilization review and quality improvement initiatives Qualifications * Active RN, Social ...
Wound Care Utilization Management RN
Woburn, MA · On-site
$39.34 - $56.20/hr
Medical
Dental
Vision
Life
Retirement
PTO
Reviews Home based services for clinical appropriateness of continued care. * Performs reviews ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
Wound Care Utilization Management RN
Woburn, MA · On-site
$39.34 - $56.20/hr
Medical
Dental
Vision
Life
Retirement
PTO
Reviews Home based services for clinical appropriateness of continued care. * Performs reviews ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
Wound Care Utilization Management RN
Woburn, MA · On-site
$39.34 - $56.20/hr
Medical
Dental
Vision
Life
Retirement
PTO
Reviews Home based services for clinical appropriateness of continued care. * Performs reviews ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
Wound Care Utilization Management RN
Woburn, MA · On-site
$39.34 - $56.20/hr
Medical
Dental
Vision
Life
Retirement
PTO
Reviews Home based services for clinical appropriateness of continued care. * Performs reviews ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
Wound Care Utilization Management RN
Woburn, MA · On-site
$39.34 - $56.20/hr
Medical
Dental
Vision
Life
Retirement
PTO
Reviews Home based services for clinical appropriateness of continued care. * Performs reviews ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
Wound Care Utilization Management RN
Woburn, MA · On-site
$39.34 - $56.20/hr
Medical
Dental
Vision
Life
Retirement
PTO
Reviews Home based services for clinical appropriateness of continued care. * Performs reviews ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...
Utilization Review Manager information
See Rowley, MA salary details
$41.8K - $54.4K
9% of jobs
$63.6K is the 25th percentile. Wages below this are outliers.
$54.4K - $66.9K
22% of jobs
$66.9K - $79.4K
11% of jobs
The median wage is $87.1K / yr.
$79.4K - $92K
14% of jobs
$92K - $104.5K
12% of jobs
$112.3K is the 75th percentile. Wages above this are outliers.
$104.5K - $117K
13% of jobs
$117K - $129.6K
13% of jobs
$129.6K - $142.1K
5% of jobs
$142.1K - $154.6K
2% of jobs
$154.6K - $167.2K
0% of jobs
$167.2K - $179.7K
0% of jobs
$41.8K
$97.6K
$179.7K
How much do utilization review manager jobs pay per year?
As of Aug 20, 2026, the average yearly pay for utilization review manager in Rowley, MA is $97,630.00, according to ZipRecruiter salary data. Most workers in this role earn between $63,800.00 and $117,500.00 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?
| Aspect | Utilization Review Manager | Utilization Review Coordinator |
|---|---|---|
| Certifications | Typically requires certifications like CCM or ACU | May require similar certifications but often less advanced |
| Work Environment | Supervises review teams, manages processes in healthcare or insurance settings | Performs case reviews, supports the review process under supervision |
| Employer & Industry | Hospitals, insurance companies, healthcare organizations | Insurance 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 cities near Rowley, MA are hiring for Utilization Review Manager jobs?
Cities near Rowley, MA with the most Utilization Review Manager job openings:
Per diem
Re-posted 11 hours ago
Job description
Position Summary
As the Complex Care Nurse Manager provides evidence-based assessments, tools, information, and resources that enhance and improve the overall health and well-being of patients and their families in settings across the healthcare continuum. The complex care manager utilizes their knowledge of social determinants of health, care management, health disparities, and cross continuum care and collaborates with patients, caregivers, physicians, nurses, and other clinical staff/directors to coordinate, facilitate, and expedite patient care services across the continuum from pre-admission to discharge and continuing care.
REQUIRED:
- Graduate of an accredited professional nursing school
- Current Massachusetts Nursing license
- Bachelor’s degree required.
- 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 required
- Demonstrated verbal, written skills
- Computer skills required
PREFERRED:
Master’s degree.