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Utilization Review Manager Jobs in Worcester, MA

GQR

RN - Case Manager

Milford, MA · On-site

$2.1K - $2.2K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Milford, Massachusetts Start Date: August 24, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay ...

Lancesoft INC

RN Case Manager

Milford, MA · On-site

$3.0K - $3.1K/wk

BSN required Active MA state RN license required 3+ yr of Hospital Case management & Utilization review required BLS (AHA) Company Description LanceSoft is rated as one of the largest staffing firms ...

GQR Healthcare

Travel Case Manager

Milford, MA · On-site

$2.1K - $2.2K/wk

Case Management/Utilization Review Shift: Day Shift Details: null Day Job Type: Travel *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible ...

Lancesoft INC

Case Management (RN)

Milford, MA · On-site

$3.0K - $3.1K/wk

BSN required Active MA state RN license required 3+ yr of Hospital Case management & Utilization review required BLS (AHA) Covid Card Company Description LanceSoft is rated as one of the largest ...

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All JobsUtilization Review JobsUtilization Review Manager JobsUtilization Review Manager Jobs in Worcester, MA

Utilization Review Manager information

See Worcester, MA salary details

$38.9K

$90.8K

$167.1K

How much do utilization review manager jobs pay per year?

As of Aug 7, 2026, the average yearly pay for utilization review manager in Worcester, MA is $90,813.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,400.00 and $109,300.00 per year, depending on experience, location, and employer.

Is utilization review a stressful job?

Utilization review managers oversee the assessment of healthcare services to ensure appropriate and efficient care, which can involve high workloads and strict deadlines, leading to stress. The job requires strong organizational skills, attention to detail, and the ability to handle complex cases, which may contribute to job-related stress for some individuals.

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 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 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.

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 most commonly searched types of Utilization Review jobs in Worcester, MA? The most popular types of Utilization Review jobs in Worcester, MA are:
What are popular job titles related to Utilization Review Manager jobs in Worcester, MA? For Utilization Review Manager jobs in Worcester, MA, the most frequently searched job titles are:
What job categories do people searching Utilization Review Manager jobs in Worcester, MA look for? The top searched job categories for Utilization Review Manager jobs in Worcester, MA are:
What cities near Worcester, MA are hiring for Utilization Review Manager jobs? Cities near Worcester, MA with the most Utilization Review Manager job openings:
Utilization Review Manager jobs near you
Infographic showing various Utilization Review Manager job openings in Worcester, MA as of August 2026, with employment types broken down into 100% Contract. Highlights an 100% In-person job distribution, with an average salary of $90,813 per year, or $43.7 per hour.

Utilization Review Clinician

TaraVista Behavioral Health Center

Devens, MA • On-site

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 24 days ago

Job description

Utilization Review Clinician

Join us as a Utilization Review Clinician!

Schedule: Monday - Friday, 40 hours onsite.

As a Utilization Review Clinician for MiraVista in Holyoke, Massachusetts, you'll bring your experience and knowledge where your voice matters. A Utilization Review Clinician is an integral part of our multidisciplinary team.

As a Utilization Review Clinician:

  • You will be an active participant in the health care team.
  • You are responsible for pre-certification, concurrent and discharge reviews, appeals and denials, and the compliance of contracted quality measures identified by managed care organizations.
  • You will serve as liaison between the hospital and outside payor sources in accordance with the mission and core principals of MiraVista Behavioral Health Center.

The Utilization Review Clinician will have the following:

  • Master's level clinician or RN.
  • Previous utilization management, preferably in an inpatient psychiatric setting
  • License eligible (LMHC or LICSW preferred) or RN
  • Possess sufficient knowledge regarding clinical treatment of psychiatric patients, the mental health care delivery system, and the managed care environment
  • Display excellent communication skills and an ability to integrate clinical and financial information in the context of an overall utilization management program
  • Requires the ability to work in a multidisciplinary, fast paced environment with a demonstrated sense of autonomy and professionalism.

When you join the growing MiraVista team as a Utilization Review Clinician, you'll receive:

  • Medical, Dental, and Vision
  • 401(k) match
  • Employer paid long term disability (LTD)
  • Short term disability (STD)
  • Employer paid life and AD&D Insurance
  • Generous Paid Time Off
  • Flexible Spending Account
  • Tuition Reimbursement

Pay Range:

Compensation will be determined based on the candidate's relevant experience.

$80,000 - $90,000

TaraVista is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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