ZipRecruiter

Log In

1

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

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

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 ...

Acadia Healthcare

Registered Nurse (RN)

Malden, MA · On-site

$42.95 - $51.28/hr

Our RNs are clinical professionals responsible for facilitating admissions, clinical intake assessments, and utilization review processes to assure continuity for the most appropriate level of care ...

STI

Case Manager - Registered Nurse

Cambridge, MA · On-site

Case Manager - Registered Nurse Cambridge, MA/Local candidates not accepted*** 3-6 Months ... Primary Responsibilities : 1. Performs utilization review and discharge planning to inpatient ...

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 Aug 1, 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.

RN Case Manager - 40 hrs Days

Boston Services

Milford, MA • On-site

Other

Re-posted 20 days ago

Job description

*** Please do not submit travelers who do not have a BSN*******The traveler will be for 40 hours, M-F, 8:00am - 4:30pm, varied days, occasional weekends and holidays. 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 Case Manager ensures the provision of a well-coordinated individualized care experience through the delivery of outcome oriented patient care within a fiscally responsible framework. This is done with an emphasis on early assessment of discharge needs, resources available, and communication among healthcare team members and family. These services are maintained along a continuum and encompass pre and post hospital needs. Requirements: BSN, current Massachusetts RN license, 3 years of prior hospital Case Management plus Utilization Review experience required.

Shift: 40 hours, M-F, 8:00am - 4:30pm, varied days, occasional weekends and holidays

Specialty Type: Nursing

Sub Specialties: Utilization Review RN

General Certifications: N/A

Please CLICK HERE to view details.