ZipRecruiter

Log In

1

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

Holyoke Hospital

VNA Registered Nurse (RN)

Holyoke, MA · On-site

$43.26 - $50.69/hr

Registered Nurse Case Manager The Holyoke Visiting Nurses Association, Inc. is looking to hire a ... Proactively facilitate coordination of services and utilization of community resources. Coordinate ...

next page

Showing results 1-20

All JobsUtilization Review Rn JobsUtilization Review Rn Jobs in Springfield, MA

Utilization Review Rn information

See Springfield, MA salary details

$21

$42

$68

How much do utilization review rn jobs pay per hour?

As of Jul 11, 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.

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 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 July 2026, with employment types broken down into 1% As Needed, 80% Full Time, 15% Part Time, 1% Temporary, and 3% Contract. Highlights an 91% Physical, 2% Hybrid, and 7% Remote job distribution, with an average salary of $87,639 per year, or $42.1 per hour.
MDS Nurse Hybrid

MDS Nurse Hybrid

Parkway Pavilion Health & Rehabilitation Center

Enfield, CT

$36.25 - $47.50/hr

Full-time

Posted 23 days ago

Job description

MDS Nurse


Parkway Pavilion, located in Enfield, CT, is seeking an MDS Nurse to join our team!

At Parkway Pavilion, our residents are provided with a full range of skilled nursing and rehabilitative services to treat and support their needs in a safe and compassionate environment that fosters independence and dignity. To meet the needs of our community, our center features a rich spectrum of care that includes, but is not limited to, Post-Acute Rehabilitation, Wound Care Management, Skilled Nursing, and Enhanced Alzheimer’s and Dementia Care

Position Summary:

The MDS Nurse (RN or LPN) plays a key role in coordinating patient assessments and ensuring accurate documentation of care throughout the resident’s stay. This position is responsible for completing and overseeing MDS assessments, maintaining compliance with state and federal regulations, and acting as the primary liaison between the interdisciplinary care team, patients, families, and external case managers. The MDS Nurse supports quality assurance initiatives and helps develop care plans that promote optimal patient outcomes.

Primary Responsibilities:

  • Coordinate and oversee each patient’s care from admission through post-discharge follow-up.

  • Serve as the key communicator between the interdisciplinary team, patients/families, and external case managers from payors and other facilities.

  • Ensure timely and accurate MDS assessments in compliance with state, federal, and facility guidelines.

  • Support quality assurance initiatives and contribute to care planning processes.

Qualifications & Prerequisites:

  • An active Connecticut RN or LPN license is required.

  • Minimum of two (2) years of healthcare experience.

  • Prior MDS experience and proficiency in PCC are required

  • Background in Utilization Review and/or Case Management is a plus.

  • Strong knowledge of managed care, Medicare, and applicable federal, state, and local regulations.

  • Extensive knowledge in managing CT Medicaid CMI

  • Understanding of growth and development across the lifespan.

  • Excellent verbal and written communication skills.

  • Ability to work collaboratively with interdisciplinary teams, patients, and families.