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How much do utilization review rn jobs pay per hour?

As of Sep 13, 2026, the average hourly pay for utilization review rn in Springfield, MA is $41.15, according to ZipRecruiter salary data. Most workers in this role earn between $32.50 and $47.26 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 Springfield, MA?

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

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

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

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

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

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

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

Utilization Review Rn jobs near you
Infographic showing various Utilization Review Rn job openings in Springfield, MA as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 16% Part Time, 3% Contract, and 1% Nights. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $85,596 per year, or $41.2 per hour.

Utilization Review Coordinator

Holyoke, MA

Valley Health Systems
Non-Profits • 201 - 500 employees
Learn more about Valley Health Systemsexternal

Full-time

Posted 16 days ago

Job description

Note: The compensation range noted above represents the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range.

TO CONDUCT UTILIZATION REVIEW FOR ALL INPATIENTS BASED ON COLLABORATIVELY DEVELOPED STANDARDS FOR LEVEL OF CARE AND QUALITY ASSURANCE; TO ASSESS PATIENTS FOR ADMISSION AND/OR UPON ADMISSION TO THE INPATIENT UNIT, AND TO ASSURE APPROPRIATE PRECERTIFICATIONS AND PAYOR APPROVALS. TO PROVIDE SAFE AND EFFECTIVE NURSING CARE AS PART OF INTERDISCIPLINARY TREATMENT TEAM, CONSISTENT WITH THE HOSPITAL'S MISSION STATEMENT, POLICIES AND PROCEDURES AND BASED ON STANDARDS OF PATIENT CARE AND STANDARDS OF NURSING PRACTICE. SCOPE OF PATIENT CARE  SERVICES PROVIDED ENCOMPASS AGE GROUPS RANGING FROM ADOLESCENTS TO GERIATRICS. ACCOUNTABILITIES INCLUDE ASSISTING PATIENTS IN MOVING AS RAPIDLY, UNEVENTFULLY, SAFELY AND EFFECTIVELY AS POSSIBLE THROUGH THE PERIOD OF HOSPITALIZATION; POSITIVE CUSTOMER, INTERDEPARTMENTAL AND INTRADEPARTMENTAL COMMUNICATIONS, MAINTAINING AND IMPROVING COMPETENCIES

  • Education: Graduate of an accredited school of Nursing or a graduate of a Masters school of Social Work or a graduate of a masters school in Mental Health Counseling.

License/Registrations: Current license within Commonwealth of Mass as a Registered Nurse, Licensed Independent Social Worker, or a Licensed Mental Health Counselor.

Experienced: A minimum of one years experience in the mental Health field

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