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

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 ...

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 ...

GQR Healthcare

Travel Case Manager

Milford, MA · On-site

$2.1K - $2.2K/wk

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

New

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · Remote

$29 - $52/hr

Current unrestricted RN license in the state of Massachusetts * 3 years of experience as a RN, ... A background in utilization review for an insurance company or experience in case management

UnitedHealth Group

Clinical Claim Review RN

Boston, MA · On-site

$29 - $52/hr

Current unrestricted RN license in the state of Massachusetts * 3+ years of experience as a RN, ... A background in utilization review for an insurance company or experience in case management

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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 Aug 2, 2026, the average hourly pay for utilization review rn in Boston, MA is $45.94, according to ZipRecruiter salary data. Most workers in this role earn between $36.30 and $52.74 per hour, depending on experience, location, and employer.

How to get into utilization review as a nurse?

To become a utilization review RN, candidates typically need a valid nursing license and experience in clinical settings. Additional certifications such as Certified Professional in Healthcare Quality (CPHQ) or case management credentials can enhance prospects, and familiarity with electronic health records and insurance policies is beneficial.

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.

How to make $300,000 as a nurse?

A Utilization Review RN can earn $300,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-paying settings like insurance companies or managed care organizations, and taking on leadership or specialized roles that offer higher compensation. Advanced skills in clinical assessment, documentation, and understanding of healthcare policies can also contribute to higher earnings.

What does an RN utilization review do?

An RN utilization review evaluates medical records and treatment plans to determine the necessity, appropriateness, and efficiency of healthcare services. They ensure compliance with insurance policies and clinical guidelines, often using electronic health records and requiring knowledge of coding and documentation standards. This role supports cost-effective patient care and involves collaboration with healthcare providers and insurance companies.

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 make $150,000 as a nurse?

A Utilization Review RN can earn $150,000 by gaining extensive experience, obtaining certifications such as Certified Review Officer (CRO), working in high-demand settings, and possibly taking on leadership or specialized roles. Increasing your workload, working overtime, or pursuing advanced education can also contribute to higher earnings within this field.

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.
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 July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 14% Part Time, 1% Temporary, and 4% Contract. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $95,545 per year, or $45.9 per hour.

Concurrent Review RN

Healthcare Support Staffing

Waltham, MA

Full-time

Re-posted 23 days ago

Job description

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Day to Day Duties:


  • This person will be reviewing charts to ensure members are receiving the most appropriate/cost effective care. They will be reviewing the progress of discharge planning to make sure they take appropriate action to keep members out of the hospital. This will be 100% onsite (no travel).
  • Company Job Description:Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews.
  • Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
  • Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
  • Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care
  • Conduct discharge planning
  • Educate providers on utilization and medical management processes
  • Provide clinical knowledge and act as a clinical resource to non-clinical team staff
  • Enter and maintain pertinent clinical information in various medical management systems
  • Direct care to participating network providers
  • Participate in utilization management committees and work on special projects related to utilization management as needed
  • Serve as a subject matter expert for questions or issues for other Concurrent Review Nurses and Prior Authorization Nurses
  • Audit case reviews to ensure compliance with utilization management policies and procedures
  • Assist with the development of utilization management workflows, policies, and procedures
Qualifications

Minimum Education/Licensures/Qualifications:

  • RN licensure
  • associates degree in nursing
  • 3+ years of UM experience in a managed care setting (this is a must)
  • 2+ years of clinical nursing experience

 Shift:

  • 8:00-5:00 100% office Based 


Additional Information

Interested in being considered?

If you are interested in being considered for this position, please click the apply button below.  Or call Ashley Greene 407-478-0332 ext 169

Healthcare Support logo

About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

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