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Utilization Reviewer Jobs in Springfield, MA (NOW HIRING)

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Utilization Reviewer information

See Springfield, MA salary details

$30.9K

$37.9K

$43.8K

How much do utilization reviewer jobs pay per year?

As of Sep 3, 2026, the average yearly pay for utilization reviewer in Springfield, MA is $37,859.00, according to ZipRecruiter salary data. Most workers in this role earn between $33,900.00 and $41,900.00 per year, depending on experience, location, and employer.

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.

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 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 do I become a utilization review nurse?

To become a utilization review nurse, you typically need to hold a registered nurse (RN) license and have experience in clinical nursing. Additional certifications such as the Certified Professional Utilization Review (CPUR) or Certified Case Manager (CCM) can enhance job prospects, and strong knowledge of healthcare policies and documentation is essential.

Is utilization review a good job?

Utilization reviewers evaluate medical necessity and appropriateness of healthcare services, often working in healthcare or insurance settings. The role requires attention to detail, knowledge of healthcare policies, and sometimes certification, with typical schedules being standard business hours. It can offer stable employment and opportunities for advancement in healthcare administration.
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The top searched job categories for Utilization Reviewer jobs in Springfield, MA are:

What cities near Springfield, MA are hiring for Utilization Reviewer jobs?

Cities near Springfield, MA with the most Utilization Reviewer job openings:

Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Springfield, MA as of August 2026, with employment types broken down into 69% Full Time, and 31% Part Time. Highlights an 74% In-person, and 26% Remote job distribution, with an average salary of $36,977 per year, or $17.8 per hour.

Utilization Review Therapist: Billing and Patient Accts- License Eligible Masters Required- Remot...

Community Health Resources

Windsor, CT • On-site

$57K/yr

Full-time

Medical, Retirement, PTO

Re-posted 5 days ago

Job description

A career can mean different things at different workplaces. Apply now to see what it means to us and what it's like to work somewhere your voice is heard, your wellness is a priority, and your success matters.

JOB TITLE:                             Utilization Review Therapist

EMPLOYMENT TYPE:          Full-time, 40 hours/wk

SCHEDULED HOURS:          Monday-Friday 8:00AM-4:30PM 

PROGRAM/LOCATION:      Billing & Patient Accounts, Windsor, CT/ Must be a resident of CT, MA, or RI only

PC#:                                        3146

ABOUT THE POSITION: Utilization Review Therapist

  • Oversees and manages all authorization activities related to IOP and Residential programs.
  • Ensures that all admissions and continued stays meet medical necessity
  • Works with service director to ensure that IOP and Residential documentation and programming meet all relevant regulatory and funder expectations. 

QUALIFICATIONS: 

Education: Master’s degree in behavioral health field

Experience: Experience in providing behavioral health treatment

Licensure/Certification/Registration:  Eligible for licensure in behavioral health field

Training: Behavioral health interventions, understanding of documentation and medical necessity expectations, working with insurers

Why Join CHR?

Award-Winning Workplace:

  • Proudly recognized as a Top Workplace for 13 consecutive years!

 Generous Time Off:

  • Enjoy ample paid time off, including a special day off for your birthday!

 Retirement Savings:

  • Benefit from contributions to your 403b Retirement Plan.

 Comprehensive Insurance:

  • Competitive premiums with added discounts on pet, auto, and home insurance!

 Education & Tuition Support:

  • Tuition reimbursement and professional development programs.
  • Student loan repayment assistance (Public Service Loan Forgiveness, Nurse Corps, NHSC/HRSA at select sites).
  • Exclusive tuition discounts for CHR employees at several local colleges/universities.

 Career Development:

  • FREE robust training curriculum, featuring our brand-new Clinical Training Series for interactive learning, practical skill enhancement, and professional growth!
  • Clinical supervision and/or mentoring available at many programs.
  • Internal career fairs: connect with recruiters to discuss your career aspirations and the various opportunities available within our over 80 programs statewide.

 Wellness Program:

  • Annual wellness stipend.
  • FREE premium subscription to the Calm app, for employees and their families
  • Fun activities like coloring contests, lunch & learns, office seasonal decorating contests, employee appreciation events, and more!
  • Up to 6 FREE confidential counseling sessions per issue, per year, for individuals, couples, & families through our EAP program

 Employee Involvement:

  • Participate in leadership luncheons with our CEO and various agency committees!

 Stay Informed:

  • Weekly video updates from our CEO and monthly newsletters to keep you in the loop.

 And So Much More:

  • Many benefits are available to all staff, regardless of the hours worked, with some subject to eligibility.

Join us at CHR and be part of an exciting, supportive, and dynamic workplace where your growth and well-being are our top priorities!

COMPENSATION*:

Starting at $57,506.80/yr minimum, and up commensurate upon experience. 

*Actual rates are determined at the time of offer and are based off of relevant experience, as well as adherence to our internal equity policy. Many of our positions offer program/location differentials and/or sign-on incentives. (Please note, for part-time positions this range would be pro-rated based on hours worked)       

CHR is an equal opportunity employer, and we encourage all to apply.

Take the first step to a meaningful career and apply to CHR today!

Apply