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Utilization Reviewer Jobs in Boston, MA (NOW HIRING)

US Tech Solutions

Utilization Review Nurse

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.

New

UHS

Utilization Review Coordinator

Brookline, MA · On-site

Responsibilities Utilization Review Coordinator Opportunity - HRI Hospital is seeking a Full-time Utilization Review Coordinator to join our skilled and dedicated team of psychiatric professionals ...

UHS

Utilization Review Coordinator

Brookline, MA · On-site

Responsibilities Utilization Review Coordinator Opportunity - HRI Hospital is seeking a Full-time Utilization Review Coordinator to join our skilled and dedicated team of psychiatric professionals ...

Uniti Med

Travel Utilization Review

Tewksbury, MA · On-site

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 ...

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All JobsUtilization Reviewer JobsUtilization Reviewer Jobs in Boston, MA

Utilization Reviewer information

See Boston, MA salary details

$33.7K

$41.3K

$47.8K

How much do utilization reviewer jobs pay per year?

As of Aug 10, 2026, the average yearly pay for utilization reviewer in Boston, MA is $41,273.00, according to ZipRecruiter salary data. Most workers in this role earn between $36,900.00 and $45,600.00 per year, depending on experience, location, and employer.

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How does a utilization reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What does a utilization reviewer do?

A Utilization Reviewer is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient records, treatment plans, and insurance policies to ensure that care meets established guidelines and standards. Their role helps control healthcare costs while maintaining quality patient care and ensuring compliance with regulatory requirements. Utilization Reviewers often communicate with healthcare providers, insurance companies, and patients to gather information and make informed decisions.

What does a utilization reviewer do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

What are the key skills and qualifications needed to thrive as a utilization reviewer?

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.
More about Utilization Reviewer jobs
What are popular job titles related to Utilization Reviewer jobs in Boston, MA? For Utilization Reviewer jobs in Boston, MA, the most frequently searched job titles are:
What job categories do people searching Utilization Reviewer jobs in Boston, MA look for? The top searched job categories for Utilization Reviewer jobs in Boston, MA are:
What cities near Boston, MA are hiring for Utilization Reviewer jobs? Cities near Boston, MA with the most Utilization Reviewer job openings:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Boston, MA as of August 2026, with employment types broken down into 84% Full Time, 3% Part Time, 3% Temporary, and 10% Contract. Highlights an 94% In-person, 3% Hybrid, and 3% Remote job distribution, with an average salary of $41,273 per year, or $19.8 per hour.

Utilization Review Nurse

US Tech Solutions

Canton, MA • On-site

$55 - $60/hr

Other

Posted 2 days ago

New

Job description

$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:

  • Candidates can be remote but must have an active unrestricted Massachusetts RN License

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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About US Tech Solutions

Sourced by ZipRecruiter

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions.

Industry

It services

Company size

1,001 - 5,000 Employees

Headquarters location

Jersey City, NJ, US

Year founded

2000

Social media

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