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

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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.

VNA Registered Nurse (RN)

Holyoke, MA • On-site

The Valley Hospital - Paramus - VAYA
See more jobs at The Valley Hospital - Paramus - VAYAexternal

Other

Posted 3 days ago

New

Job description

The Holyoke Visiting Nurses Association, Inc. is looking to hire a Registered Nurse working full-time for home care experience. The Registered Nurse Case Manager carries full and ultimate responsibility for the quality of nursing care provided to patients who are at their homes based on desired outcomes consistent with evidence-based guidelines and quality care standards.

  • Ultimately responsible for the design and implementation of the plan of care, and initiating changes in the plan of care when appropriate.
  • Accountable for evaluation and improvement of clinical and financial patient outcomes.
  • Proactively facilitate coordination of services and utilization of community resources.
  • Coordinate care and communication between team members and physicians to ensure appropriateness of care.
  • Complete, maintain and submit accurate and timely documentation and relevant clinical notes regarding the client's condition and all care & treatment given.
Requirements:
  • MA Registered Nurse (RN) License
  • Demonstrated computer & time management skills
  • 1-3 years home care experience

Apply