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42 utilization nurse jobs at 16 companies in Boston, MA

5d
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Utilization Nurse
Plymouth, Massachusetts, United States
$37-$82/hr OnsitePart Time
Beth Israel Lahey Health
Beth Israel Lahey Health: Integrated regional healthcare provider operating hospitals and clinical centers.
3+ YOECurrent Massachusetts RN license, three years of broad hospital clinical experience, and utilization management experience within the last three years; InterQual knowledge required.
InterQual, Allscripts
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5d
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Utilization Management Nurse BWH
Boston, Massachusetts, United States
$42-$106/hr RemotePart Time
Mass General Brigham: Provides integrated medical care, research, and clinical training services.
5+ YOEMassachusetts RN license, hospital or healthcare experience, utilization review and medical criteria experience, five years of medical or surgical nursing experience, and strong clinical, organizational, communication, and computer skills.
Milliman, InterQual
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1mo
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Sr Utilization Management Nurse RN - Remote
Boston, Massachusetts, United States
$73k-$130k/yr FieldFull Time
UnitedHealth Group
UnitedHealth GroupNYSE: UNH: Provides health insurance and technology-enabled health care services.
4+ YOEActive MA RN license, RAC/CT MDS certification prior to start, 4+ years nursing long-term care/record review, knowledge of Medicare/Medicaid and UM processes, HIPAA compliance, ability to travel across Massachusetts and reliable transportation.
Microsoft Office
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1w
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RN Manager Utilization Review- Full Time- Days
Manchester, New Hampshire, United States
OnsiteFull Time
SolutionHealth
SolutionHealth: Regional health system providing primary and specialty medical care.
Bachelor's degree or higher in nursing, active New Hampshire or compact-state RN license, utilization review and InterQual knowledge, and leadership skills; managerial experience and CCM or ACM certification preferred.
InterQual
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1mo
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Director, Utilization Review
Exeter, New Hampshire, United States
$135k-$155k/yr OnsiteFull Time
Cobalt Benefits Group
Cobalt Benefits Group: Manages self-funded health and dental benefit plans for employers.
5+ MgmtActive RN license, 5+ years utilization review leadership, knowledge of MCG and regulatory standards, experience with claims integration, and familiarity with interoperability/automation tools.
MCG, EDI
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Wound Care Utilization Management RN
Indianapolis or Iselin or Tampa or Miami or Wilmington or Cincinnati or St. Louis or Walnut Creek or Las Vegas or Woburn or Grand Prairie or Chicago or California or Illinois or Massachusetts or Nevada or New Jersey
$39-$56/hr RemoteFull Time
Elevance Health
Elevance HealthNYSE: ELV: Provides health insurance plans and integrated healthcare services.
3+ YOERequires an associate degree in nursing or equivalent background, 3+ years of healthcare experience, active unrestricted RN license, and wound-care certification such as WOCN or CWS.
medical records
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4w
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Behavioral Health Intake and Utilization Review Coordinator
Providence, Rhode Island, United States
OnsiteFull Time
CharterCARE Health of Rhode Island
CharterCARE Health of Rhode Island: Regional healthcare network providing hospital and medical services.
2+ YOERN in Rhode Island with 2+ years behavioral health experience, knowledge of levels-of-care and utilization review, EHR proficiency, strong assessment, communication, and organizational skills.
MCG, InterQual, EHR, Microsoft Office Suite, API, Oracle, HealthStream, Meditech
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ABA Behavioral Health Utilization Manager (Outpatient and Non-24 Hour Diversionary Services)
Charlestown or Massachusetts
$70k-$101k/yr RemoteFull Time
WellSense Health Plan
WellSense Health Plan: A nonprofit health insurance provider offering Medicare, Medicaid, and individual plans.
5+ YOEMaster's in behavioral health or bachelor's in nursing; 5–7 years of behavioral health insurance experience, utilization management expertise, active MA and/or NH independent licensure, and BCBA credential.
Microsoft Outlook, Microsoft Word, Microsoft Excel
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1mo
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Registered Nurse, Homecare
Warwick, Rhode Island, United States
OnsiteFull Time
Care New England Health System
Care New England Health System: Integrated non-profit health system providing hospital and medical services.
5+ YOEBachelor of Nursing and RN license required, minimum 5 years clinical experience, experience with case management, utilization review, and discharge planning.
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Registered Nurse, Care Manager
Warwick, Rhode Island, United States
OnsiteTemporary
Care New England Health System
Care New England Health System: Integrated non-profit health system providing multi-specialty medical care.
2+ YOEActive unrestricted Rhode Island RN license, graduate of accredited nursing school; bachelor’s in nursing preferred; minimum 2 years recent acute care experience; knowledge of case management, utilization review, quality assurance; CCM or ACM certification required or to be obtained within 24 months.
InterQual, ICD 10
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Registered Nurse, Care Manager
Warwick, Rhode Island, United States
OnsiteFull Time
Care New England Health System
Care New England Health System: Integrated non-profit health system providing hospital and medical services.
2+ YOEActive Rhode Island RN license, 2+ years recent acute care experience, knowledge of case management and utilization review, certification in case management (CCM or ACM) within 24 months preferred, strong interpersonal and analytical skills.
InterQual, SIMS Plus, ICD-10
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2mo
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RN Case Manager, Inpatient Cardiology
Boston, Massachusetts, United States
$94k-$150k/yr OnsiteFull Time
Boston Children's Hospital
Boston Children's Hospital: Providing comprehensive pediatric healthcare and medical research services.
5+ YOEBachelor of Nursing required, 5+ years nursing experience (pediatrics preferred), Massachusetts RN license required, CCM preferred or willing to obtain, experience in discharge planning/utilization management.
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1mo
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RN Care Coordinator (Per Diem)
Brighton, Massachusetts, United States
$41-$95/hr OnsitePart Time, Temporary
Boston Medical Center
Boston Medical Center: Provides specialized medical care and academic healthcare training.
2+ YOEActive Massachusetts RN license, BLS required; 2 years med-surg, 1 year discharge planning, 2 years case/utilization management experience; nursing degree (diploma/ASN/BSN; BSN preferred); InterQual experience preferred.
InterQual, ICD-9, CPT
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RN Case Manager
Hingham, Massachusetts, United States
$44-$54/hr RemoteFull Time
Blue Cross Blue Shield of Massachusetts
Blue Cross Blue Shield of Massachusetts: Provides health and dental insurance plans and managed care.
3+ YOEActive Massachusetts RN license required, 3-5 years clinical experience, utilization management preferred, ability to assess needs, coordinate care, and document care plans.
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1mo
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Per Diem Case Manager
Weymouth, Massachusetts, United States
$59-$86/hr OnsitePart Time
South Shore Health
South Shore Health: Regional health system providing comprehensive medical and community care.
3+ YOEActive RN licensure, 3+ years acute care experience preferred, ACM or CCM within two years, InterQual certification, strong communication, critical thinking, utilization review and discharge planning skills.
eDischarge, EHR, Interqual, MCCM, Epic, Workday
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4d
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Case Mgr - Beh Health
Providence or Arizona or Connecticut or Florida or Georgia or Louisiana or Massachusetts or North Carolina or Oklahoma or Rhode Island or South Carolina or Texas or Virginia
$74k-$110k/yr RemoteFull Time
Blue Cross & Blue Shield of Rhode Island
Blue Cross & Blue Shield of Rhode Island: Provides health and dental insurance plans to Rhode Islanders.
3+ YOERequires an unrestricted RN, doctoral psychologist, LMHC, or LICSW license; 3–5 years of clinical or managed-care experience; CCM certification within three years; utilization management and care coordination knowledge.
Employee Assistance, FEP
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1mo
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Case Manager-MNA MRMC - Case Mgmt - 32 hr days
Milford, Massachusetts, United States
$84k-$177k/yr OnsiteFull Time
UMass Memorial Health
UMass Memorial Health: Provides integrated medical care and clinical research in Massachusetts.
3+ YOEBSN and current Massachusetts RN license required, 3+ years clinical experience (3–5 years preferred), utilization review/quality or community experience, strong interpersonal and analytical skills; CCM certification preferred.
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2mo
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Director, Medical Policy
Canton, Massachusetts, United States
$162k-$243k/yr HybridFull Time
Point32Health
Point32Health: Provides health insurance plans and medical well-being services.
10+ YOE5+ MgmtRequires active RN licensure, Bachelor's degree (Master's preferred), 10+ years in medical policy/utilization/quality improvement with 5 years managerial experience, policy and regulatory expertise, strong communication and analytic skills.
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2w
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Manager of Case Management, Case Management, 40-Hours, Days, 8:00am - 4:30pm, Monday - Friday, No weekends or holidays, Massachusetts RN License Required
Gardner, Massachusetts, United States
$45-$60/hr OnsiteFull Time
Heywood Healthcare
Heywood Healthcare: Independent community healthcare system providing comprehensive medical services.
5+ YOEActive Massachusetts RN license, BSN required (must matriculate within 1 year if not), MSN preferred; prior management experience; 5+ years case management and 3+ years acute inpatient case management; utilization review experience.
InterQual
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