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Manager Utilization Management Jobs in Massachusetts

Tenet Health

Director - Case Management

Worcester, MA · On-site

Accredited Case Manager (ACM) * Manage department operations to assure effective throughput and reimbursement for services provided * Lead the implementation and oversight of the hospital Utilization ...

Tenet Health

Director - Case Management

Worcester, MA · On-site

Accredited Case Manager (ACM) * Manage department operations to assure effective throughput and reimbursement for services provided * Lead the implementation and oversight of the hospital Utilization ...

Tenet Health

Director - Case Management

Worcester, MA · On-site

$118K - $183K/yr

Utilization Management supporting medical necessity and denial prevention; Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction; Care ...

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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Massachusetts

Manager Utilization Management information

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

To thrive as a Manager Utilization Management, you need a thorough understanding of healthcare regulations, utilization review processes, and case management, often supported by a clinical degree (such as RN) and relevant experience. Familiarity with utilization management software, claims processing systems, and potentially certifications like CCM (Certified Case Manager) or ACM (Accredited Case Manager) is important. Strong leadership, analytical thinking, and effective communication help you guide teams and collaborate with providers and payers. These skills ensure efficient resource use, compliance, and quality patient care within managed care organizations.

What is the difference between Manager Utilization Management vs Utilization Review Nurse?

AspectManager Utilization ManagementUtilization Review Nurse
CredentialsRN, often with management or utilization review certificationsRN, with certifications in utilization review or case management
Work EnvironmentSupervises teams, manages policies, oversees utilization review processesPerforms patient chart reviews, assesses medical necessity, collaborates with providers
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare organizations
Search & Comparison IntentYesYes

While both roles focus on utilization review, the Manager Utilization Management oversees teams and policies, ensuring efficient resource use, whereas the Utilization Review Nurse conducts patient-specific reviews to determine medical necessity. The manager role involves leadership and strategic planning, while the nurse role is more clinical and review-focused.

What are some common challenges faced by a manager utilization management, and how can they effectively address them?

Managers in Utilization Management often encounter challenges such as balancing quality patient care with cost containment, navigating evolving healthcare regulations, and managing diverse teams. To effectively address these issues, successful managers develop strong communication skills, stay updated on industry standards, and foster collaboration between clinical and administrative staff. Implementing robust training programs and utilizing data-driven decision-making can also help ensure compliance and improve overall team performance.

What does a manager utilization management do?

A Manager of Utilization Management oversees the process of evaluating the necessity, appropriateness, and efficiency of healthcare services provided to patients. They lead a team that reviews medical claims and care plans to ensure compliance with clinical guidelines and regulatory requirements. Their role often involves collaborating with physicians, nurses, insurance companies, and other stakeholders to optimize patient outcomes while managing healthcare costs. Additionally, they are responsible for implementing policies, training staff, and ensuring that utilization management activities align with organizational goals.

What are the most commonly searched types of Utilization Management jobs in Massachusetts?

The most popular types of Utilization Management jobs in Massachusetts are:

What are popular job titles related to Manager Utilization Management jobs in Massachusetts?

For Manager Utilization Management jobs in Massachusetts, the most frequently searched job titles are:

What job categories do people searching Manager Utilization Management jobs in Massachusetts look for?

The top searched job categories for Manager Utilization Management jobs in Massachusetts are:

What cities in Massachusetts are hiring for Manager Utilization Management jobs?

Cities in Massachusetts with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Massachusetts as of August 2026, with employment types broken down into 1% As Needed, 84% Full Time, 13% Part Time, and 2% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution.

Correspondence Coordinator, Utilization Management

Saviance

Charlestown, MA • On-site

$21 - $28.25/hr

Other

Re-posted 17 days ago

Job description

Job Title

Qualifications: High school diploma or equivalent Education preferred: AS Degree Experience required: At least 1 year of general clerical experience At least 1 year generating professional correspondence using Microsoft Word Experience preferred: At least 1 year in a health insurance or medical office Regular exposure to/use of medical terminology Microsoft Excel Certification or Conditions of Employment: Pre-employment background check Competencies, skills, and attributes: A willingness to learn, follow directions and work compatibly with others Ability to prioritize work Strong oral and written communication skills Detail oriented with excellent proof reading, data entry and editing skills Regular and reliable attendance is an essential function of the position Work is normally performed in a typical interior/office work environment No or very limited physical effort required; no or very limited exposure to physical risk Ability to work OT during peak periods Other: Other duties as assigned Skill in operating/using standard office machines/equipment

Responsibilities: Gathers information from the clinical documentation system and the clinical staff who have reviewed a case. Organizes the information into messages appropriate for member receipt and for provider receipt. Initiates follow up with clinical staff when clarification is required. Identifies the appropriate letter template and transcribes information from the messages onto the template. Generates final letter(s) and mails or transmits electronically, as appropriate. Maintains mandated time-frames and quality standards. Collaborates with supervisor to identify and implement process improvements. Provides excellent customer service. Other duties as assigned.

Comments/Special Instructions Position to start of as remote, moving back to Charleston office when and if appropriate. Applicants must be available to work both remote/in person

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About Saviance

Sourced by ZipRecruiter

Saviance is a modern consulting firm providing a variety of professional services to its clients in the US. We bring twenty three years of experience to the table. Our consultants are qualified experts and extremely talented. We understand the business behind the technology, and work with many of the top Fortune 100 companies and provide innovative, scalable, robust and secure solutions. At the forefront of the Staffing and IT Solutions industry, Saviance is certified by NMSDC as a Tier 1, Minority Business Enterprise (MBE) . We are a self- certified Small Business and self- certified Woman Owned Business committed to maximizing global workforce solutions on behalf of our clients, empowering businesses and talent through applied human intelligence. We are a Diversity Supplier with global reach specializing in a business services blend of talent, technology, and a relentless commitment to customer success. It’s our diversity that’s acts as a core component of our culture, our approach to business, and the opportunities we provide to our clients and our employees.

Industry

It services

Company size

201 - 500 Employees

Headquarters location

East Rutherford, NJ, US

Year founded

1999

Social media

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