Canton, MA · On-site
$55 - $60/hr
Ensure all utilization review activities meet regulatory turnaround time requirements. * Collaborate with Medical Directors for complex cases, denial recommendations, and clinical escalations.
Canton, MA · On-site
$55 - $60/hr
Ensure all utilization review activities meet regulatory turnaround time requirements. * Collaborate with Medical Directors for complex cases, denial recommendations, and clinical escalations.
Tewksbury, MA · On-site
$1.6K/wk
Utilization Review * Discipline: Therapy * Start Date: 08/24/2026 * Duration: 52 weeks * 40 hours per week * Shift: 8 hours, days * Employment Type: Travel Benefits: * Day 1 Insurance * Cigna medical ...
Tewksbury, MA · On-site
$1.6K/wk
Utilization Review * Discipline: Therapy * Start Date: 08/24/2026 * Duration: 52 weeks * 40 hours per week * Shift: 8 hours, days * Employment Type: Travel Benefits: * Day 1 Insurance * Cigna medical ...
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working 24 hours per week. Working hours are 8am - 4:30pm, 3 weekdays per week. The schedule will require ...
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working 24 hours per week. Working hours are 8am - 4:30pm, 3 weekdays per week. The schedule will require ...
Pembroke, MA · On-site
$5.0K/mo
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working 24 hours per week. Working hours are 8am - 4:30pm, 3 weekdays per week. The schedule will require ...
Pembroke, MA · On-site
$5.0K/mo
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working 24 hours per week. Working hours are 8am - 4:30pm, 3 weekdays per week. The schedule will require ...
Pembroke, MA · On-site
$5.0K/mo
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working 24 hours per week. Working hours are 8am - 4:30pm, 3 weekdays per week. The schedule will require ...
Pembroke, MA · On-site
$5.0K/mo
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working 24 hours per week. Working hours are 8am - 4:30pm, 3 weekdays per week. The schedule will require ...
Pembroke, MA · On-site
$5.0K/mo
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working 24 hours per week. Working hours are 8am - 4:30pm, 3 weekdays per week. The schedule will require ...
Pembroke, MA · On-site
$5.0K/mo
Responsibilities Utilization Review Coordinator Opportunity - This is a part time position, working 24 hours per week. Working hours are 8am - 4:30pm, 3 weekdays per week. The schedule will require ...
The P2P Utilization Review Nurse functions with a high degree of autonomy and clinical judgment, managing a high volume of complex cases across multiple entities. Working in close collaboration with ...
The P2P Utilization Review Nurse functions with a high degree of autonomy and clinical judgment, managing a high volume of complex cases across multiple entities. Working in close collaboration with ...
The P2P Utilization Review Nurse functions with a high degree of autonomy and clinical judgment, managing a high volume of complex cases across multiple entities. Working in close collaboration with ...
The P2P Utilization Review Nurse functions with a high degree of autonomy and clinical judgment, managing a high volume of complex cases across multiple entities. Working in close collaboration with ...
Ensures that Utilization Review nurses are consistently recommending the appropriate admission status and provides education as needed. * Interacts with physicians to manage high risk patients most ...
Ensures that Utilization Review nurses are consistently recommending the appropriate admission status and provides education as needed. * Interacts with physicians to manage high risk patients most ...
$41.71 - $105.65/hr
Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. The nurse is a part of the care coordination staff and ...
$41.71 - $105.65/hr
Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. The nurse is a part of the care coordination staff and ...
Boston, MA · On-site
$41.71 - $105.65/hr
Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. The nurse is a part of the care coordination staff and ...
Boston, MA · On-site
$41.71 - $105.65/hr
Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. The nurse is a part of the care coordination staff and ...
Boston, MA · On-site +1
$41.71 - $105.65/hr
Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. The nurse is a part of the care coordination staff and ...
Boston, MA · On-site +1
$41.71 - $105.65/hr
Through sound knowledge of utilization management, the nurse is able to assess a patient's level of care after review of the medical record. The nurse is a part of the care coordination staff and ...
Waltham, MA · On-site
Participate in utilization management committees and work on special projects related to ... Audit case reviews to ensure compliance with utilization management policies and procedures ...
Waltham, MA · On-site
Participate in utilization management committees and work on special projects related to ... Audit case reviews to ensure compliance with utilization management policies and procedures ...
Boston, MA · On-site
$79.17 - $86.72/hr
Non-patient Care (utilization Review) Registered Nurse job at Supplemental Health Care. Boston, MA. Non-patient Care (utilization Review) RN Opportunity Take your career to the next level with an ...
New
Boston, MA · On-site
$79.17 - $86.72/hr
Non-patient Care (utilization Review) Registered Nurse job at Supplemental Health Care. Boston, MA. Non-patient Care (utilization Review) RN Opportunity Take your career to the next level with an ...
New
Sr Utilization Management Nurse Optum is a global organization that delivers care, aided by ... Review the entire medical record for accuracy, and appropriate clinical treatment * Communicate ...
Sr Utilization Management Nurse Optum is a global organization that delivers care, aided by ... Review the entire medical record for accuracy, and appropriate clinical treatment * Communicate ...
Sr Utilization Management Nurse Optum is a global organization that delivers care, aided by ... Review the entire medical record for accuracy, and appropriate clinical treatment * Communicate ...
Sr Utilization Management Nurse Optum is a global organization that delivers care, aided by ... Review the entire medical record for accuracy, and appropriate clinical treatment * Communicate ...
Sr Utilization Management Nurse Optum is a global organization that delivers care, aided by ... Review the entire medical record for accuracy, and appropriate clinical treatment * Communicate ...
Sr Utilization Management Nurse Optum is a global organization that delivers care, aided by ... Review the entire medical record for accuracy, and appropriate clinical treatment * Communicate ...
Sr Utilization Management Nurse Optum is a global organization that delivers care, aided by ... Review the entire medical record for accuracy, and appropriate clinical treatment * Communicate ...
New
Sr Utilization Management Nurse Optum is a global organization that delivers care, aided by ... Review the entire medical record for accuracy, and appropriate clinical treatment * Communicate ...
New
This role is primarily responsible for conducting utilization management reviews for post-acute and extended care services, including Skilled Nursing Facility (SNF), Acute Rehabilitation, and ...
New
This role is primarily responsible for conducting utilization management reviews for post-acute and extended care services, including Skilled Nursing Facility (SNF), Acute Rehabilitation, and ...
New
As a Sr Utilization Management Nurse in the Boston MA Regional Area, the role centers on ensuring ... Review the entire medical record for accuracy, and appropriate clinical treatment * Communicate ...
As a Sr Utilization Management Nurse in the Boston MA Regional Area, the role centers on ensuring ... Review the entire medical record for accuracy, and appropriate clinical treatment * Communicate ...
$23.24 - $27.94
2% of jobs
$27.94 - $32.64
9% of jobs
$35.86 is the 25th percentile. Wages below this are outliers.
$32.64 - $37.34
21% of jobs
The median wage is $41.15 / hr.
$37.34 - $42.04
23% of jobs
$42.04 - $46.74
13% of jobs
$50.40 is the 75th percentile. Wages above this are outliers.
$46.74 - $51.44
10% of jobs
$51.44 - $56.15
8% of jobs
$56.15 - $60.85
5% of jobs
$60.85 - $65.55
5% of jobs
$65.55 - $70.25
2% of jobs
$70.25 - $74.95
2% of jobs
$23
$45
$74
A Utilization Review (UR) job involves assessing the medical necessity, efficiency, and appropriateness of healthcare services. UR professionals, often nurses or healthcare specialists, review patient records, insurance claims, and treatment plans to ensure they meet industry standards and payer requirements. They work with healthcare providers, insurance companies, and regulatory agencies to optimize care while controlling costs. Their goal is to balance quality patient care with cost-effective resource utilization.
A typical day in Utilization Review involves reviewing patient medical records, evaluating the necessity and appropriateness of proposed treatments or services, and documenting recommendations based on clinical criteria and insurance policies. Utilization Review specialists often collaborate closely with physicians, nurses, and insurance representatives to gather additional information and clarify cases. While much of the role is desk-based and may include remote work options, it requires regular communication with both clinical and administrative teams. This position offers variety and challenge, as no two cases are exactly alike, and there are often opportunities to advance into supervisory or quality improvement roles within the department.
To thrive in Utilization Review, professionals typically need a background in nursing or healthcare, strong clinical assessment capabilities, and a thorough understanding of medical guidelines and insurance regulations. Familiarity with electronic medical records (EMR) systems and utilization management software, and often certification such as Certified Utilization Review Specialist (CURN), are important. Excellent critical thinking, attention to detail, and strong communication skills enable effective case evaluation and collaboration with healthcare teams. These skills and qualifications ensure objective, accurate decisions that support cost-effective, quality patient care within compliance standards.
The most popular types of Utilization Review jobs in Boston, MA are:
For Utilization Review jobs in Boston, MA, the most frequently searched job titles are:
The top searched job categories for Utilization Review jobs in Boston, MA are:
Cities near Boston, MA with the most Utilization Review job openings:
$55-$60 per hour
Canton, MA
Contract
Duration: 6 Month Contract (Possibility of Extension)
Position Overview
We are seeking an experienced Utilization Management (UM) Registered Nurse to support outpatient utilization review and prior authorization activities for a leading healthcare organization. The ideal candidate will have a strong background in managed care, utilization management, medical necessity review, prior authorization, and outpatient clinical review.
This role is responsible for reviewing medical records, evaluating the medical necessity of requested services using established clinical guidelines, collaborating with physicians and healthcare providers, and ensuring timely authorization decisions while maintaining compliance with regulatory standards.
Key Responsibilities
Perform outpatient utilization management (UM) and medical necessity reviews for prior authorization and precertification requests.
Review clinical documentation and determine benefit eligibility using evidence-based clinical guidelines and health plan policies.
Evaluate requests for outpatient procedures, surgeries, imaging, therapies, specialty medications, and other healthcare services.
Ensure all utilization review activities meet regulatory turnaround time requirements.
Collaborate with Medical Directors for complex cases, denial recommendations, and clinical escalations.
Communicate authorization decisions with physicians, provider offices, hospitals, and healthcare facilities.
Participate in appeal reviews and provide clinical recommendations when appropriate.
Maintain accurate documentation within utilization management systems.
Monitor cases for quality, compliance, and adherence to organizational policies.
Identify opportunities for process improvement and contribute to quality initiatives.
Serve as a clinical resource for internal teams regarding utilization management guidelines and medical necessity criteria.
Required Qualifications
Active, unrestricted Registered Nurse (RN) license.
Associate Degree in Nursing (ADN) required.
Minimum 5 years of RN clinical experience.
Minimum 3-5 years of Utilization Management (UM), Case Management, Prior Authorization, or Medical Management experience.
Previous Managed Care, Health Plan, Medicare, Medicaid, or Commercial Insurance experience.
Strong knowledge of:
Utilization Management (UM)
Medical Necessity Review
Prior Authorization
Precertification
InterQual and/or MCG Guidelines
Experience reviewing outpatient clinical services.
Excellent clinical assessment and critical thinking skills.
Strong communication skills with providers and interdisciplinary teams.
Ability to work independently in a remote environment.
Comfortable using multiple systems while managing a high-volume workload.
Preferred Qualifications
BSN preferred.
Experience with outpatient utilization management.
Experience using InterQual and/or MCG clinical criteria.
Experience with Medicare Advantage or Commercial Health Plans.
Previous experience with appeals, grievances, or denial reviews.
Knowledge of NCQA, CMS, and utilization management regulatory requirements.
Note:
About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .
US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
AI Statement: By applying, you acknowledge that AI-assisted tools may be used during hiring.
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US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.
It services
1,001 - 5,000 Employees
Jersey City, NJ, US
2000
