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

Mission Hospital

RN - Case Manager

Springfield, MA · On-site

$2.0K/wk

Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with ...

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How much do utilization review rn jobs pay per hour?

As of Aug 21, 2026, the average hourly pay for utilization review rn in Springfield, MA is $42.13, according to ZipRecruiter salary data. Most workers in this role earn between $33.32 and $48.37 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:

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

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

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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, 80% Full Time, 14% Part Time, 4% Contract, and 1% Nights. Highlights an 90% Physical, 3% Hybrid, and 7% Remote job distribution, with an average salary of $87,639 per year, or $42.1 per hour.

Utilization Review Clinician

TaraVista Behavioral Health

Holyoke, MA • On-site

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 3 days ago

New

Job description

Join us as a Utilization Review Clinician!

Schedule: Monday - Friday, 40 hours onsite.

As a Utilization Review Clinician for MiraVista in Holyoke, Massachusetts, youll bring your experience and knowledge where your voice matters. A Utilization Review Clinician is an integral part of our multidisciplinary team.

As a Utilization Review Clinician:

  • You will be an active participant in the health care team.

  • You are responsible for pre-certification, concurrent and discharge reviews, appeals and denials, and the compliance of contracted quality measures identified by managed care organizations.

  • You will serve as liaison between the hospital and outside payor sources in accordance with the mission and core principals of MiraVista Behavioral Health Center.

The Utilization Review Clinician will have the following:

  • Master's level clinician or RN.

  • Previous utilization management, preferably in an inpatient psychiatric setting

  • License eligible (LMHC or LICSW preferred) or RN

  • Possess sufficient knowledge regarding clinical treatment of psychiatric patients, the mental health care delivery system, and the managed care environment

  • Display excellent communication skills and an ability to integrate clinical and financial information in the context of an overall utilization management program

  • Requires the ability to work in a multidisciplinary, fast paced environment with a demonstrated sense of autonomy and professionalism.

When you join the growing MiraVista team as a Utilization Review Clinician, youll receive:

  • Medical, Dental, and Vision

  • 401(k) match

  • Employer paid long term disability (LTD)

  • Short term disability (STD)

  • Employer paid life and AD&D Insurance

  • Generous Paid Time Off

  • Flexible Spending Account

  • Tuition Reimbursement

Pay Range:

Compensation will be determined based on the candidate's relevant experience.

$80,000 - $90,000

MiraVista is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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