ZipRecruiter

Log In

1

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

Holyoke Hospital

VNA Registered Nurse (RN)

Holyoke, MA · On-site

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 ...

previous pagenext page

Showing results 21-40

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 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:

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, 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.

Care Management Assistant- 40hrs

Connecticut Children's

Hartford, CT

Full-time

Posted 23 days ago

Connecticut Children's Medical Center rating

7.7

Company rating: 7.7 out of 10

Based on 45 frontline employees who took The Breakroom Quiz

226th of 1,061 rated hospitals

Job description

The Care Management Assistant (CMA), functions as a member of the multidisciplinary health care team with guidance from the nurse case managers, social workers and utilization review nurses. The CMA provides broad scale administrative, project, and operations support to the Center for Care Coordination inpatient teams, within the hospital setting. In addition, this position works closely with the Case Management, Social Work and Utilization Review staff to provide discharge planning assistance to RN Case Managers and Social Workers.  All administrative and support activities are completed in accordance with CT Children's and department policies and procedures.

Connecticut Children's is the only health system in Connecticut that is 100% dedicated to children. Established on a legacy that spans more than 100 years, Connecticut Children's offers personalized medical care in more than 30 pediatric specialties across Connecticut and in two other states. Our transformational growth establishes us as a destination for specialized medicine and enables us to reach more children in locations that are closer to home. Our breakthrough research, superior education and training, innovative community partnerships, and commitment to diversity, equity and inclusion provide a welcoming and inspiring environment for our patients, families and team members.

At Connecticut Children's, treating children isn't just our job - it's our passion. As a leading children's health system experiencing steady growth, we're excited to expand our team with exceptional team members who share our vision of transforming children's health and well-being as one team. 

Education and/or Experience Required:

  • Education: GED or High School Diploma required

Education and/or Experience Preferred:

  • Education: Associate's Degree preferred
  • Experience:  5-7 years of increasing experience directly related to supporting children/families in a pediatric setting

Knowledge, Skills and Abilities:

Knowledge:

  • Knowledge of pediatric growth and development 0-21 yrs.
  • Demonstrates current knowledge of Nurse Case Manager, Utilization Review Nurse, and Social Work activities as appropriate and seeks professional help when unfamiliar with specific regulations or department policies and procedures.
  • Applies understanding of payer reimbursements and contracted terms to identify denied services.

Skills:

  • Proficient in Word, Excel.
  • Ability to prioritize the department's needs in an organized manner based on available resources of time and personnel.
  • Collaborates with department leaders to ensure seamless transitions in function and maintain information flow.
  • Demonstrates effective communication skills using interest-based communication and following chain-of-command.

Abilities:

  • Communicate effectively and efficiently to internal and external customers.
  • Prioritize responsibilities and adjusts time to accommodate the needs of the department.
  • Organize and manage projects.
  • Collect data and input according.
     
  • Support case managers, social workers and utilization review staff with discharge planning process, DME, administrative tasks. -20%
  • Conduct discharge follow-up phone calls as needed in conjunction with other Center inpatient and outpatient staff. -5%
  • Assist families with resolving issues and/or escalate to case management, providers etc. to assist families. 10%
  • Manage DME inventory: supply, storage, and track issues. -5%
  • Assist with tracking of Center metrics as requested by Center leadership. -5%
  • Assures that day-to-day deliverables align with policy and procedures to include regulatory and compliance requirements. -5%
  • As necessary, sends clinical information on behalf of the Center to third-party payers. -2.5%
  • Engagement in Center activities that will create opportunities for broad impact on child/family health and well-being (i.e. research, innovation, forums, presentations) -2.5%
     

What Connecticut Children's Medical Center employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply