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

UHS

Intake Registered Nurse (RN) - Part Time

Pembroke, MA · On-site

$5.0K/mo

... Hospital Unit, Utilization Review and Business office. * Maintain accurate, up-to-date bed ... Benefits for our Registered Nurse (RN) includes: * Student loan repayment - $200/month * Tuition ...

Superbeo

RN-Case Manager

Cambridge, MA · On-site

Primary Responsibilities: 1. Performs utilization review and discharge planning to inpatient ... Current state license as a Registered Nurse 2. Three years of medical/surgical nursing care ...

UHS

Intake Registered Nurse (RN) - Part Time

Pembroke, MA · On-site

$5.0K/mo

... Hospital Unit, Utilization Review and Business office. * Maintain accurate, up-to-date bed ... Benefits for our Registered Nurse (RN) includes: * Student loan repayment - $200/month * Tuition ...

Acadia Healthcare

RN Admissions PRN

Malden, MA

$42.95 - $51.28/hr

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

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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 Jul 12, 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:
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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

Registered Nurse (RN) Part Time

Tufts Medicine Behavioral Health Hospital

Malden, MA • On-site

$42.95 - $51.28/hr

Part-time

Posted 5 days ago

Job description

Overview

Tufts Medicine Behavioral is searching forPT RN's for Nights!

Pay: $42.95-$51.28 (depending on experience)

Acadia Healthcare is a leading provider of behavioral healthcare services across the United States. Acadia operates a growing network of 250 plus behavioral healthcare facilities with approximately 11,100 beds in 39 states and Puerto Rico. With more than 23,000 employees serving approximately 75,000 patients daily, Acadia is the largest stand-alone behavioral health company in the U.S.

Acadia Healthcare's purpose is to Lead Care With Light and our mission is to be a world-class organization that sets the standard for excellence in the treatment of mental health and addiction concerns. We strive to maintain our standing as a thought leader in the behavioral healthcare industry, providing treatment that is synonymous with compassion and innovation.

Tufts Medicine, a leading integrated academic health system in Massachusetts, and Acadia Healthcare, the largest standalone provider of behavioral health services in the U.S., have partnered to create the Tufts Medicine Behavioral Health Hospital, a state-of-the-art, 144-bed facility in Malden, Massachusetts. Slated to open in fall 2025, this hospital is designed to address the growing need for high-quality behavioral health services in the region.

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 for patients and their benefit/resource utilization.

Responsibilities

REGISTERED NURSE ESSENTIAL FUNCTIONS

  • Provide and coordinate care by assessing patients' physical and behavioral health needs.
  • Develop and implement nursing care plans.
  • Maintain medical records and educate patients and their families about various physical and behavioral health conditions.
  • Provide nursing care and services within the standards and scope of nursing practice as defined within the state Nurse Practice Act regulations, policies, procedures, and protocols, as well as facility and corporate policies and procedures.
  • Ensure physicians' orders are legible if taken verbally and transcribed appropriately per policy and procedure.
  • Ensure patients' status is assessed on an ongoing basis and pertinent information is gathered and documented.
  • Notify physicians of significant changes in status such as difficulties with detox, medical emergency, change in medical status regarding response to medications, and related challenges.
  • Ensure that initial nursing treatment plans are completed upon admission and that all nursing treatment plans are specific to assessed needs.
  • Demonstrate knowledge and utilization of universal precautions in providing direct patient care.
  • Accurately administer medications per ordered note.
  • Document accurate count of controlled substance medication administration on required documents.
  • Complete admission and discharge processing efficiently and accurately as directed.
  • Exhibit therapeutic rapport with patients by maintaining professional boundaries, respecting personal space, giving patients direct attention, and maintaining rational detachment.
  • Provide direction or coordinate the activities of the unit as directed.
  • Communicate therapeutically and professionally with patients, visitors, co-workers, and others involved inpatient treatment.
Qualifications

EDUCATION/LICENSURE/EXPERIENCE/SKILL REQUIREMENTS

  • Must have graduated from an accredited school of nursing.
  • Must possess a current Registered Nurse (RN) license as required by the state of employment or be eligible to practice nursing in accordance with state requirements
  • One year of nursing experience; previous psychiatric, mental, behavioral, or substance use nursing experience a plus
  • CPR and de-escalation and restraint certification required (training available upon hire and offered by facility).
  • First aid may be required based on state or facility requirements.

Pay Range: $42.95 to $51.28/hr.

We are committed to providing equal  employment opportunities to all applicants for employment regardless of an individual's characteristics protected by applicable state, federal and local laws.

AHRN

#LI-LM1

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Employment Type: PART_TIME

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