ZipRecruiter

Log In

1

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

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

Active, unrestricted Registered Nurse (RN) license. * Associate Degree in Nursing (ADN) required ... Utilization Management (UM) * Medical Necessity Review * Prior Authorization * Precertification

GQR Global Markets

RN - Case Manager

Everett, MA · On-site

$2.9K - $3.0K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Everett, Massachusetts Start Date: January 27, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay ...

GQR

RN - Case Manager

Everett, MA · On-site

$2.9K - $3.0K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Everett, Massachusetts Start Date: January 27, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay ...

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · Remote

The Clinical Claim Review RN will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive ...

next page

Showing results 1-20

All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Boston, MA

Utilization Review Rn information

See Boston, MA salary details

$23

$45

$74

How much do utilization review rn jobs pay per hour?

As of Sep 13, 2026, the average hourly pay for utilization review rn in Boston, MA is $45.79, according to ZipRecruiter salary data. Most workers in this role earn between $36.20 and $52.60 per hour, depending on experience, location, and employer.

What is a utilization review RN?

A Utilization Review RN is a registered nurse who evaluates the necessity, appropriateness, and efficiency of healthcare services and treatments provided to patients. They review medical records, collaborate with healthcare teams, and ensure that patient care meets established guidelines and payer requirements. Their role helps control costs, optimize care, and support compliance with healthcare regulations. Utilization Review RNs often work in hospitals, insurance companies, or managed care organizations.

How does a utilization review RN collaborate with physicians and other healthcare professionals during the patient care review process?

A Utilization Review RN works closely with physicians, case managers, and other healthcare team members to ensure that patients receive appropriate care while adhering to regulatory and insurance guidelines. This collaboration often involves discussing clinical findings, clarifying documentation, and negotiating care plans to meet both patient needs and payer requirements. Effective communication and teamwork are essential, as Utilization Review RNs frequently serve as liaisons between clinical staff and insurance representatives to facilitate timely authorizations and prevent unnecessary delays in patient care.

What are the key skills and qualifications needed to thrive as a utilization review RN, and why are they important?

To thrive as a Utilization Review RN, you need a current RN license, strong clinical assessment skills, and knowledge of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or ACM is often required. Excellent critical thinking, communication, and negotiation skills help you advocate for appropriate patient care while collaborating with providers and payers. These skills ensure cost-effective, quality care and compliance with regulatory standards in healthcare delivery.

What is the difference between Utilization Review Rn vs Case Manager?

AspectUtilization Review RnCase Manager
CredentialsRN license, certifications in utilization reviewRN license, certifications in case management
Work EnvironmentHospitals, insurance companies, healthcare facilitiesHospitals, community agencies, insurance companies
Primary FocusReviewing medical necessity and appropriateness of careCoordinating patient care and discharge planning

Utilization Review Rns primarily focus on evaluating the necessity of medical treatments, while Case Managers coordinate patient care and discharge planning. Both roles require RN licensure and certifications, but their daily responsibilities and work environments differ slightly, with Utilization Review Rns concentrating on review processes and Case Managers on patient advocacy and care coordination.

How to get into utilization review as a registered nurse?

To become a utilization review RN, you typically need a valid registered nurse license and experience in clinical settings. Additional certifications such as the Certified Professional in Healthcare Quality (CPHQ) or case management certification can enhance job prospects, and familiarity with electronic health records (EHR) systems is often required.

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

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

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

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

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Boston, MA as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 13% Part Time, 4% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $95,540 per year, or $45.9 per hour.

Utilization Review Nurse

Canton, MA • On-site

US Tech Solutions
IT Services • 1 - 5K employees
Learn more about US Tech Solutionsexternal

$55 - $60/hr

Other

Re-posted 5 days ago

Job description

$55-$60 per hour

Canton, MA

Contract

Duration: 6 Month Contract (Possibility of Extension)

Position Overview

We are seeking an experienced Utilization Management (UM) Registered Nurse to support outpatient utilization review and prior authorization activities for a leading healthcare organization. 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 reviewing medical records, evaluating the medical necessity of requested services using established clinical guidelines, collaborating with physicians and healthcare providers, and ensuring timely authorization decisions while maintaining compliance with regulatory standards.

Key Responsibilities

  • Perform outpatient utilization management (UM) and medical necessity reviews for prior authorization and precertification requests.

  • Review clinical documentation and determine benefit eligibility using evidence-based clinical guidelines and health plan policies.

  • Evaluate requests for outpatient procedures, surgeries, imaging, therapies, specialty medications, and other healthcare services.

  • Ensure all utilization review activities meet regulatory turnaround time requirements.

  • Collaborate with Medical Directors for complex cases, denial recommendations, and clinical escalations.

  • Communicate authorization decisions with physicians, provider offices, hospitals, and healthcare facilities.

  • Participate in appeal reviews and provide clinical recommendations when appropriate.

  • Maintain accurate documentation within utilization management systems.

  • Monitor cases for quality, compliance, and adherence to organizational policies.

  • Identify opportunities for process improvement and contribute to quality initiatives.

  • Serve as a clinical resource for internal teams regarding utilization management guidelines and medical necessity criteria.

Required Qualifications

  • Active, unrestricted Registered Nurse (RN) license.

  • Associate Degree in Nursing (ADN) required.

  • Minimum 5 years of RN clinical experience.

  • Minimum 3-5 years of Utilization Management (UM), Case Management, Prior Authorization, or Medical Management experience.

  • Previous Managed Care, Health Plan, Medicare, Medicaid, or Commercial Insurance experience.

  • Strong knowledge of:

  • Utilization Management (UM)

  • Medical Necessity Review

  • Prior Authorization

  • Precertification

  • InterQual and/or MCG Guidelines

  • Experience reviewing outpatient clinical services.

  • Excellent clinical assessment and critical thinking skills.

  • Strong communication skills with providers and interdisciplinary teams.

  • Ability to work independently in a remote environment.

  • Comfortable using multiple systems while managing a high-volume workload.

Preferred Qualifications

  • BSN preferred.

  • Experience with outpatient utilization management.

  • Experience using InterQual and/or MCG clinical criteria.

  • Experience with Medicare Advantage or Commercial Health Plans.

  • Previous experience with appeals, grievances, or denial reviews.

  • Knowledge of NCQA, CMS, and utilization management regulatory requirements.

Note:

  • Candidates can be remote but must have an active unrestricted Massachusetts RN License

About US Tech Solutions:

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .

US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

AI Statement: By applying, you acknowledge that AI-assisted tools may be used during hiring.

US Tech Solutions logo

About US Tech Solutions

Sourced by ZipRecruiter

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Jersey City, NJ, US

Year founded

2000

Social media

FacebookTwitter

View All US Tech Solutions Jobs

Apply