Top 29 Utilization review Jobs in Hyannis, Ma

$1,000 Sign-On Bonus! Field Registered Nurse - (Hybrid Remote - Massachusetts)
Maximus —Massachusetts
- $45.67 - $48.08 an hour
- Full-time
- Hybrid work
- RN License
- Hospital
- HIPAA
- Mileage reimbursement
- Health insurance
14d
Case Manager
Cape Cod Healthcare —Hyannis, MA
- $42.04 - $89.99 an hour
- Full-time
- Nursing
- RN License
- Hospital
Site Medical Director
OUTER CAPE HEALTH SERVICES INC —Harwich Port, MA
- $105,000 - $255,000 a year
- Weekends as needed
- Medicine
- Microsoft Outlook
- BC/BE
Quick Apply
14d
Director of Rehabilitation
Reliant Rehabilitation —Brewster, MA
- $80,000 - $100,000 a year
- Management
- Customer service
- Physical & Rehabilitation Medicine
- Health insurance
- Dental insurance
Financial Counselor
Cape Cod Healthcare —Hyannis, MA
- $21.81 - $35.84 an hour
- No weekends
- Hospital
- Basic math
- English
Case Manager (Per Diem) - Spaulding Sandwich
Rehabilitation Hospital of the Cape and Islands Corporation —East Sandwich, MA
- $28.20 - $68.49 an hour
- Part-time
- Hospital
- Physical & Rehabilitation Medicine
- Licensed Clinical Social Worker
- Opportunities for advancement
Quick Apply
RN Case Manager
Cape Cod Post Acute —Brewster, MA
- $55 - $60 an hour
- Full-time
- Nursing
- Skilled nursing facility
- Bachelor of Science
- Dental insurance
- Tuition reimbursement
Quick Apply
12d
Behavioral Health Clinician (LICSW, LMHC, LCSW, LMFT)
Cape Cod Healthcare —Hyannis, MA
- $32.31 - $53.13 an hour
- Weekends as needed
- Acute care
- LMFT
- Hospital
Therapist - Salaried Clinician
Cape Cod Healthcare —Hyannis, MA
- $66,872 - $86,944 a year
- Weekends as needed
- LMFT
- Licensed Clinical Social Worker
- HIPAA
PHP Clinician
Gosnold —Centerville, MA
- $34 - $39 an hour
- Full-time
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- 403(b) matching
- Paid holidays
Quick Apply
Clinical Director
High Point & Affiliated Organizations —Hyannis, MA
- $93,600 - $120,640 a year
- Full-time
- LMFT
- Doctoral degree
- Current TB test
- Paid training
- Continuing education credits
Quick Apply
7d
Assistant Director of Detox (Full-Time in Wareham, MA)
Gosnold —Wareham, MA
- $110,000 - $120,000 a year
- Full-time
- LMFT
- Management
- Addiction Medicine
- 403(b) matching
- Paid holidays
Quick Apply
Clinical Supervisor - Taunton Area
Justice Resource Institute —Yarmouth Port, MA
- $70,000 - $80,000 a year
- Full-time
- Management
- Mid-level
- 3 years
- Health insurance
- Dental insurance
Quick Apply
14d
Clinical Supervisor-Plymouth and Cape Areas
Justice Resource Institute —Yarmouth Port, MA
- $70,000 - $80,000 a year
- Full-time
- Management
- Mid-level
- 3 years
- Health insurance
- Dental insurance
Quick Apply
14d
NP/PA, Psych
Cape Cod Healthcare —Hyannis, MA
- $153,565 - $169,076 a year
- Part-time
- Nursing
- Psychiatry
- Hospital
Senior Director of Clinical Services
Gosnold —Wareham, MA
- $130,000 a year
- Full-time
- LMFT
- Addiction Medicine
- 5 years
- 403(b) matching
- Paid holidays
Quick Apply
1d
Nurse Practitioner/Physician Assistant, Psych (Per Diem)
Cape Cod Healthcare —Hyannis, MA
- $153,565 - $169,076 a year
- 8 hour shift
- Nursing
- Psychiatry
- Hospital
Psychiatric Nurse Practitioner
Harbor Health Services, Inc. —Hyannis, MA
- $129,970 - $195,955 a year
- 18 years or older
- Spanish
- Nursing
- Loan repayment program
- Disability insurance
Quick Apply
Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)
UT Health Science Center at San Antonio —United States
- Hospital
- Outpatient experience
- 3 years
Quick Apply

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Senior Counselor/Case Manager
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Utilization Management Behavioral Health Professional
Humana —Ohio
Bachelor's degree in nursing OR a master's degree in a Human Services field with a professional individual or compact licensure in the state of Kentucky without…
$65,000 - $88,600 a year
4d
Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
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utilization review jobs near hyannis, ma

$1,000 Sign-On Bonus! Field Registered Nurse - (Hybrid Remote - Massachusetts)

Maximus -
Massachusetts

Apply Now

Job Details

Full-time
$45.67 - $48.08 an hour
14 days ago

Benefits

Mileage reimbursement
Health insurance
Dental insurance
401(k)
Tuition reimbursement
Paid time off
401(k) matching

Qualifications

Collaborate with healthcare professionals
Caregiving documentation requirements
Utilization review
RN License
Initial assessment (medical evaluation)
Experience working with individuals with cognitive disabilities
HIPAA
Managing patients as a nurse case manager
Care planning in social services
Intellectual disabilities support
Clinical assessment documentation
Experience working with adults with disabilities
Adults with developmental disabilities
Productivity software
Behavioral and mental health screening
Patient assessment visits
Experience working with individuals from underserved communities
Experience working with individuals with intellectual disabilities
Home & community care experience

Full Job Description

Are you an RN looking for a rewarding career outside of the hospital? Join Maximus and help Massachusetts residents access the care and services they need to live safely and independently in their communities. This is an opportunity to build meaningful one-on-one relationships with members while enjoying a predictable Monday–Friday, 8:00 AM–5:00 PM schedule, the independence to manage your day, and the satisfaction of making a lasting difference.

As a Clinical Assessor, you'll conduct comprehensive in-person assessments in members' homes, hospitals, and other community settings to evaluate medical, functional, behavioral health, and social needs. You'll develop person-centered service plans, collaborate with healthcare providers and community partners, educate members and caregivers on available resources, and advocate for vulnerable populations. Your work will directly support individuals in maintaining their independence while ensuring high-quality, compliant care through the MassHealth Long-Term Services and Supports (LTSS) program.

This is a field-based position serving a designated geographic region, with eligible business travel reimbursed at the current IRS federal mileage rate of 76.0 cents per mile. Territories are assigned to help minimize travel while allowing you to provide essential services throughout your community.

If you're passionate about community-based nursing, value autonomy, and want to improve lives every day, we'd love to hear from you.

Now offering a $1,000 sign-on bonus! Join our team as a Field Registered Nurse supporting members throughout the state of Massachusetts while enjoying the flexibility of a hybrid remote schedule. Apply today to learn more about our competitive compensation, comprehensive benefits, and rewarding career opportunities.

Opportunities are available in several Massachusetts communities, including Boston, Lowell, Brockton, New Bedford, Fall River, Worcester, Springfield, Lynn, and Lawrence.

About the Program

The Commonwealth of Massachusetts Executive Office of Health and Human Services (EOHHS), through the MassHealth Office of Long-Term Services and Supports (LTSS), provides a robust system of care for individuals of all ages with disabilities and chronic conditions. The program is designed to help Massachusetts residents live with independence and dignity, participate in their communities, and improve their overall quality of life.

As the Public Assessors Option (PAO), Maximus provides education to providers, conducts comprehensive in-person assessments, and offers call center support for the following LTSS programs:

Adult Day Health (ADH)
Adult Foster Care (AFC)
Group Adult Foster Care (GAFC)
Personal Care Attendant (PCA)

As the PAO, Maximus serves as a point of entry for LTSS inquiries and initial contacts while conducting timely, high-quality, consistent, and accurate assessments to determine clinical eligibility for these programs.

Why Nurses Choose Maximus

Monday–Friday schedule (8:00 AM–5:00 PM)
IRS federal mileage reimbursement for eligible business travel
Independence to manage your own daily schedule
Performance bonus opportunities
Meaningful one-on-one interactions that improve lives
Professional growth and tuition reimbursement
Comprehensive benefits and 401(k) with company match

Essential Duties and Responsibilities:

Responsible for completing medical and/or behavioral health assessments within contract requirements
Conducts on-site, video call and/or telephonic assessments to determine an individual’s needs for services and supports, eligibility, level of care or related outcome
Perform all job duties in compliance with Person First standards, HIPAA guidelines, and company confidentiality policies and procedures.
Travel may be required based on program contract requirements
Performs other related duties as assigned.
Conduct assessments using standardized tools (UCA, TTT) to identify medical, functional, and social needs
Develop and manage service plans for complex or high-acuity members, coordinating with healthcare providers, case managers, and community resources
Evaluate eligibility for recommended referrals to other professionals or agencies
Maintain compliance with state and federal regulations, Medicaid/LTSS program guidelines, and electronic health record systems
Collaborate with care teams to revise care plans as needs change, ensuring alignment with member goals
Provide education to members, families, and caregivers on available services and options
Document assessments and care activities accurately to support billing, compliance, and quality reporting
Advocate for members to help them remain in preferred living environments and maintain independence

Minimum Requirements:

Current Registered Nurse (RN) license valid in the state of practice is required
High School Degree or equivalent required- Minimum 2 years of clinical experience required
An active, unencumbered Registered Nurse (RN) license in the state of Massachusetts
Minimum of two (2) years of relevant post-graduate clinical experience as a Registered Nurse
Experience working with vulnerable populations, including individuals with behavioral health needs, intellectual and developmental disabilities (I/DD), and those requiring long-term services and supports (LTSS)
Experience conducting clinical or functional assessments in home or community-based settings, such as behavioral health evaluations, level of care determinations, or utilization reviews
Knowledge of community-based services, care coordination, and person-centered care planning
Familiarity with MassHealth programs, LTSS, and Home and Community-Based Services (HCBS) waiver programs
Proficiency in Microsoft Office applications.- Experience documenting assessments in electronic systems

Home Office Requirements:

Maximus provides company-issued computer equipment
Reliable high-speed internet service
Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity- Minimum 5 Mpbs upload speeds
Private and secure workspace

Pay: $45.67 - $48.08 per hour

Benefits:

401(k)
Dental insurance
Health insurance
Paid time off

Work Location: On the road

Apply Now

Refine Your Search

utilization review jobs in hyannis, ma

$1,000 Sign-On Bonus! Field Registered Nurse - (Hybrid Remote - Massachusetts)

Case Manager

Site Medical Director

Director of Rehabilitation

Financial Counselor

Case Manager (Per Diem) - Spaulding Sandwich

RN Case Manager

Behavioral Health Clinician (LICSW, LMHC, LCSW, LMFT)

Therapist - Salaried Clinician

PHP Clinician

Clinical Director

Assistant Director of Detox (Full-Time in Wareham, MA)

Clinical Supervisor - Taunton Area

Clinical Supervisor-Plymouth and Cape Areas

NP/PA, Psych

Senior Director of Clinical Services

Nurse Practitioner/Physician Assistant, Psych (Per Diem)

Psychiatric Nurse Practitioner

Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)

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