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Utilization Review Jobs in Lawrence, MA (NOW HIRING)

GQR Global Markets

RN Case Manager

Everett, MA · On-site

$2.9K - $3.0K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Everett, Massachusetts Start Date: January 27, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay ...

GQR

RN - Case Manager

Everett, MA · On-site

$2.9K - $3.0K/wk

Contract - W2 Case Management/Utilization Review Registered Nurse (RN) Job Location: Everett, Massachusetts Start Date: January 27, 2026 Profession: Registered Nurse (RN) Facility: Estimated Pay ...

Acadia Healthcare

RN Admissions PT

Haverhill, MA · On-site

$40 - $50/hr

Clinical professional is responsible for facilitating admissions, clinical intake assessments, and utilization review processes to assure continuity for the most appropriate level of care for ...

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All JobsUtilization Review JobsUtilization Review Jobs in Lawrence, MA

Utilization Review information

See Lawrence, MA salary details

$22

$44

$72

How much do utilization review jobs pay per hour?

As of Aug 23, 2026, the average hourly pay for utilization review in Lawrence, MA is $44.36, according to ZipRecruiter salary data. Most workers in this role earn between $35.05 and $50.96 per hour, depending on experience, location, and employer.

What is a utilization review?

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.

What does a utilization review do?

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.

What are the key skills and qualifications needed to thrive in utilization review?

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.

How do I get into a utilization review?

To become a utilization review specialist, typically a healthcare or related degree such as nursing, health administration, or social work is required. Certification in case management or utilization review, like the Certified Professional in Healthcare Quality (CPHQ), can enhance job prospects, and strong analytical and communication skills are essential for success in the role.

Is utilization review a stressful job?

Utilization review is a healthcare role that involves evaluating medical necessity and appropriateness of services, often under strict deadlines and documentation requirements. The job can be stressful due to high workload, the need for accuracy, and managing complex cases, but stress levels vary based on work environment and individual coping skills.

What are the most commonly searched types of Utilization Review jobs in Lawrence, MA?

The most popular types of Utilization Review jobs in Lawrence, MA are:

What are popular job titles related to Utilization Review jobs in Lawrence, MA?

For Utilization Review jobs in Lawrence, MA, the most frequently searched job titles are:

What job categories do people searching Utilization Review jobs in Lawrence, MA look for?

The top searched job categories for Utilization Review jobs in Lawrence, MA are:

What cities near Lawrence, MA are hiring for Utilization Review jobs?

Cities near Lawrence, MA with the most Utilization Review job openings:

Utilization Review jobs near you
Infographic showing various Utilization Review job openings in Lawrence, MA as of August 2026, with employment types broken down into 1% As Needed, 80% Full Time, 16% Part Time, 2% Contract, and 1% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $92,267 per year, or $44.4 per hour.

RN, Acute Care Case Manager - Full Time

SolutionHealth

Nashua, NH • On-site

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 27 days ago

Job description

Come work at the best place to give and receive care!
Job Description:
Who We Are
Southern New Hampshire Health has been a cornerstone of the region since 1893, delivering high-quality, compassionate care close to home. Anchored by Southern New Hampshire Medical Center, a 188-bed, DNV-accredited hospital in downtown Nashua with a Level III-N trauma center, Level II Special Care Nursery, and Magnet® designation for nursing excellence, we offer a full spectrum of services from primary care to advanced diagnostics and specialized treatments. Our medical staff includes over 500 providers from Foundation Medical Partners and local practices. Foundation Medical Partners, our multi-specialty group, spans 70+ practices across southern New Hampshire and northern Massachusetts, providing coordinated, patient-centered care to thousands each year.
About the Job
The RN Acute Care Case Manager evaluates patients' health status, support systems, and care needs to facilitate safe and effective discharge planning. This role develops multidisciplinary, culturally appropriate, and age-specific discharge plans while managing utilization review processes, determining appropriate levels of care, and coordinating care transitions. The RN Acute Care Case Manager works collaboratively with physicians, clinical staff, patients, families, and community resources to optimize patient outcomes and ensure compliance with regulatory and insurance requirements.
What You'll Do
  • Evaluate patient health status, caregiver capabilities, and support systems to facilitate discharge planning.
  • Develop and coordinate multidisciplinary discharge plans that support safe transitions of care.
  • Perform utilization review activities and determine appropriate levels of care using InterQual criteria.
  • Conduct concurrent clinical reviews and communicate with insurance providers to support authorization and prevent denials.
  • Review medical records to assess medical necessity and utilization of services throughout the patient stay.
  • Coordinate patient-centered discharge planning meetings with the care team.
  • Participate in interdisciplinary care planning and patient-care team huddles.
  • Ensure patients and families receive appropriate post-discharge resources and have choice in agency or facility selection.
  • Collaborate with physicians, nurses, therapists, social workers, and community agencies to improve care coordination.
  • Mobilize resources to achieve clinical outcomes within desired timeframes.
  • Serve as a resource regarding utilization review processes and support appeals as needed.
  • Ensure compliance with discharge planning regulations and standards.
  • Issue Important Messages from Medicare within required timeframes.
  • Participate in quality improvement and performance improvement initiatives.
  • Maintain confidentiality and protect patient privacy.
  • Perform other duties as assigned.

Who You Are / Requirements
  • Bachelor's degree in Nursing
  • Current Registered Nurse (RN) licensure in the State of New Hampshire required.
  • Case Manager Certification preferred.
  • Minimum of 3-5 years of case management-related healthcare experience required.
  • Seven (7) years of case management-related healthcare experience may be substituted for the bachelor's degree requirement.
  • Experience with InterQual, MCG, Milliman, or other healthcare acute care criteria preferred.
  • Acute care utilization review and/or discharge planning experience preferred.
  • Knowledge of care coordination principles and practices.
  • Excellent written and verbal communication skills.
  • Proficiency with Microsoft Office applications.
  • Strong analytical thinking and critical decision-making abilities.
  • Ability to manage competing priorities in a fast-paced healthcare environment.
  • Ability to collaborate effectively across interdisciplinary teams.
  • Ability to achieve competency in:
    • Abuse reporting
    • Guardianship
    • Discharge planning and case coordination
    • Community resource referrals
    • Utilization review

Why You'll Love Us
  • Southern NH Medical Center is a 5-time Magnet designated hospital
  • Health, dental, prescription, and vision coverage for full-time & part-time employees
  • Medical, dental, and vision coverage
  • Life insurance
  • Short- and long-term disability
  • Flexible Spending Accounts (FSA)
  • Competitive pay
  • Tuition Reimbursement
  • Nursing Student Loan Paydown Program
  • 403(b) Retirement Savings Plan
  • Education & Paid training courses for continued career progression
  • & So much more!

Work Shift:
Fu7ll time, 32 hours, First Shift
SolutionHealth is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law.

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