ZipRecruiter

Log In

1

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

Intermountain Health

RN Care Manager

Springfield, MA · On-site

$41.20 - $62.17/hr

The RN Hospital Care Manager I delivers comprehensive care management services to designated ... Demonstrated experience in case management, utilization review, value-based care, and/or discharge ...

New

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

$20

$41

$67

How much do utilization review rn jobs pay per hour?

As of Sep 11, 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.

Registered Nurse (RN) Inpatient Care Coordinator

Springfield, MA

Trinityhealth
Health Care and Social Assistance • 10K+ employees
Learn more about Trinityhealthexternal

$83K - $133K/yr

Full-time

Posted yesterday

New

Trinity Health rating

6.6

Company rating: 6.6 out of 10

Based on 354 frontline employees who took The Breakroom Quiz

Job description

Employment Type:Full timeShift:Day ShiftDescription:

At Mercy Medical Center, our RN Inpatient Care Coordinators are responsible for coordinating patient care, assessing patient needs, and developing individualized care plans. They collaborate closely with healthcare providers, monitor patient progress, and ensure smooth transitions between levels of care while advocating for patients' overall well-being.

What you will do

  • Coordinate and manage inpatient care from admission through discharge.

  • Assess patients' clinical, psychosocial, and discharge planning needs.

  • Develop, implement, and monitor individualized plans of care.

  • Collaborate with physicians, nurses, social workers, case managers, and ancillary staff.

  • Monitor patient progress and adjust care plans based on ongoing and anticipated needs.

Minimum Qualifications

  • Education: Graduate of an accredited college or university affiliated nursing program. BSN graduate preferred.

  • Licensure: Current Licensure as a Registered Nurse RN in Massachusetts.

  • Certification: BLS (AHA/ARC). Certification in Case Management (ACM, CCM) required within one year of employment after meeting minimum requirements.

Preferred Skills:

  • Experience: 3-5 years of experience in case management, utilization review, or a related role preferred

  • Hospital or community-based healthcare experience preferred

  • Demonstrated proficiency with nationally recognized medical utilization criteria, including MCG, InterQual, and others as applicable

  • Solid understanding of managed care methodologies and applicable CMS/HCFA, OBRA, and Massachusetts state regulatory requirements

Work Schedule:

  • Full Time-40 Hours/4-10 Hour Shifts-7:00am-5:30pm

  • Every Other Weekend/Holiday

Pay Range: $83,304.00 to $133,328.00

Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.

Ministry/Facility Information

Mercy Medical Center has established itself as one of the leading providers of health care services in Western Massachusetts. Mercy Medical Center is a 182-bed acute care hospital in Springfield. Other facilities include Mercy's Rehabilitation Hospital, a comprehensive hospital-based rehabilitation center on the campus of Mercy Medical Center and Brightside for Families and Children, an outpatient service offering counseling and family support programs.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

What Trinity Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Trinity Health logo

About Trinity Health

Sourced by ZipRecruiter

Trinity Health Ann Arbor is a 537 -bed teaching hospital located on 340 acre campus. Recognized by IBM Watson as a Top 100 Hospital and #1 Teaching Hospital, Trinity Health Ann Arbor has been a leading health care provider for more than 100 years. Trinity Health has received numerous local and national awards in recognition of our leadership, quality outcomes, and clinical excellence.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Livonia, MI, US

View All Trinity Health Jobs

Apply