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Utilization Review Manager Jobs in Worcester, MA

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Utilization Review Manager information

See Worcester, MA salary details

$38.9K

$90.7K

$166.9K

How much do utilization review manager jobs pay per year?

As of Aug 30, 2026, the average yearly pay for utilization review manager in Worcester, MA is $90,684.00, according to ZipRecruiter salary data. Most workers in this role earn between $59,300.00 and $109,100.00 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 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 84% Full Time, 13% Part Time, and 3% Contract. Highlights an 84% Physical, 2% Hybrid, and 14% Remote job distribution, with an average salary of $90,813 per year, or $43.7 per hour.

RN Case Manager - Milford Regional, 32 hours, Days

UMass Memorial Health

Milford, MA • On-site

Full-time

Re-posted 10 days ago

UMass Memorial Health rating

7.3

Company rating: 7.3 out of 10

Based on 157 frontline employees who took The Breakroom Quiz

304th of 895 rated healthcare providers

Job description

Are you a current UMass Memorial Health caregiver? Apply now through Workday.
Exemption Status:
Exempt
Hiring Range:
$84,011.20 - $176,987.20
Please note that the final offer may vary within this range based on a candidate's experience, skills, qualifications, and internal equity considerations.
Schedule Details:
Holidays - One Major Summer Holiday, Holidays - One Major Winter Holiday, Monday through Friday, Weekends - Every Third Weekend
Scheduled Hours:
8:00am - 4:30pm
Shift:
1 - Day Shift, 8 Hours (United States of America)
Hours:
32
Cost Center:
26000 - 4402 Case Management
Union:
MNA-Milford Regional Medical Center (Massachusetts Nurses Association)
This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.
Everyone Is a Caregiver
At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.
In collaboration with other members of the healthcare team, the Case Manager is accountable for coordinating and facilitating the management of care for an assigned group of patients. The goal is to ensure a well-coordinated, individualized care experience through outcome-oriented care within a fiscally responsible framework. This includes early assessment of discharge needs, resource availability, and communication among healthcare team members and families, spanning pre- and post-hospital care.
I. Major Responsibilities:
1. Assessment: Evaluate appropriateness of inpatient admission and assess patient needs to identify high-risk individuals and initiate referrals.
2. Multidisciplinary Practice Guidelines: Participate in the development and monitoring of interdisciplinary guidelines and variance tracking.
3. Collaborative Practice: Work with physicians and healthcare providers to enhance quality of care and utilization management.
4. Discharge Planning: Facilitate timely discharge through early intervention and coordination of services.
5. Data Management: Monitor compliance, collect utilization data, and identify cases for quality and utilization review.
II. Position Qualifications:
License/Certification/Education:
Required:
1. BSN
2. Current Massachusetts RN license
Preferred:
1. CCM certification
Experience/Skills:
Required:
1. 3-5 years of clinical experience with sound judgment and knowledge of current medical care and support systems
2. Previous utilization review, quality assurance, or community experience
3. Strong interpersonal and analytical skills
Preferred:
1. N/A
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.
We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.
As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.
If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.

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