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Utilization Review Np Jobs in Springfield, MA (NOW HIRING)

PULSE PRIMARY CARE

Nurse Practitioner

Springfield, MA · On-site

$110K - $160K/yr

Nurse Practitioner Job Summary Under the direction of the Supervising Physician, the Primary Care ... Perform comprehensive physical assessments and review patient medical histories. * Order, interpret ...

PULSE PRIMARY CARE

Nurse Practitioner

Springfield, MA · On-site

$110K - $160K/yr

Nurse Practitioner Job Summary Under the direction of the Supervising Physician, the Primary Care ... Perform comprehensive physical assessments and review patient medical histories. * Order, interpret ...

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All JobsUtilization Review Np JobsUtilization Review Np Jobs in Springfield, MA

Utilization Review Np information

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$21

$42

$68

How much do utilization review np jobs pay per hour?

As of Jul 16, 2026, the average hourly pay for utilization review np in Springfield, MA is $42.13, according to ZipRecruiter salary data. Most workers in this role earn between $33.32 and $48.37 per hour, depending on experience, location, and employer.

What are some common challenges Utilization Review Nurse Practitioners face when collaborating with healthcare providers and insurance companies?

Utilization Review Nurse Practitioners often navigate the challenge of balancing patient advocacy with payer requirements. They must effectively communicate clinical justifications to both healthcare providers and insurance representatives, sometimes mediating disagreements over the necessity of certain treatments or hospital stays. Staying up-to-date with ever-changing insurance guidelines and ensuring timely documentation can also be demanding, but strong organizational and interpersonal skills help facilitate smooth collaboration and successful patient outcomes.

What does a Utilization Review NP do?

A Utilization Review Nurse Practitioner (NP) evaluates the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. They review patient records, treatment plans, and insurance coverage to ensure that care meets established guidelines and regulatory requirements. Utilization Review NPs help coordinate care, prevent unnecessary procedures, and support cost-effective healthcare delivery while ensuring patient safety and quality outcomes.

What are the key skills and qualifications needed to thrive as a Utilization Review Nurse Practitioner, and why are they important?

To thrive as a Utilization Review Nurse Practitioner (NP), you need expert clinical judgment, a strong understanding of healthcare regulations, and advanced assessment skills, typically supported by an active NP license and clinical experience. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of insurance guidelines such as Medicare and Medicaid are commonly required. Excellent communication, attention to detail, and critical thinking are vital soft skills for effective case evaluations and collaboration with providers. These competencies ensure accurate, efficient reviews that support quality care, compliance, and cost-effective treatment decisions.

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

AspectUtilization Review NpUtilization Review Nurse
CredentialsMaster's degree in Nursing, Nurse Practitioner certification, state licensureRegistered Nurse (RN) license, possibly with certification in utilization review
Work EnvironmentHealthcare facilities, insurance companies, utilization review organizationsHospitals, insurance companies, outpatient clinics
Job ResponsibilitiesAssess medical necessity, authorize treatments, make clinical decisions, often with greater autonomyReview medical records, support authorization processes, follow established guidelines

Utilization Review NPs typically have advanced clinical training and greater decision-making authority compared to Utilization Review Nurses. Both roles focus on evaluating medical necessity, but NPs often perform more complex assessments and can make independent recommendations, whereas nurses support the review process under supervision or guidelines.

What are popular job titles related to Utilization Review Np jobs in Springfield, MA? For Utilization Review Np jobs in Springfield, MA, the most frequently searched job titles are:
What job categories do people searching Utilization Review Np jobs in Springfield, MA look for? The top searched job categories for Utilization Review Np jobs in Springfield, MA are:
What cities near Springfield, MA are hiring for Utilization Review Np jobs? Cities near Springfield, MA with the most Utilization Review Np job openings:
Utilization Review Np jobs near you
Infographic showing various Utilization Review Np job openings in Springfield, MA as of July 2026, with employment types broken down into 12% As Needed, 58% Full Time, 24% Part Time, and 6% Contract. Highlights an 94% In-person, and 6% Remote job distribution, with an average salary of $87,639 per year, or $42.1 per hour.

Utilization Review Clinician

TaraVista Behavioral Health

Holyoke, MA • On-site

Other

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 7 days ago

Job description

Join us as a Utilization Review Clinician!

Schedule: Monday - Friday, 40 hours onsite.

As a Utilization Review Clinician for MiraVista in Holyoke, Massachusetts, youll 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, youll 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

MiraVista 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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