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Manager Utilization Management Jobs in Boston, MA

STI

Case Manager - Registered Nurse

Cambridge, MA · On-site

... Utilization Management Committees to accurately determine appropriateness for inpatient and outpatient care. 3. Communicates with attending and house staff when options to inpatient care are ...

Superbeo

RN-Case Manager

Cambridge, MA · On-site

Two years of case management or utilization management experience required. 3. Basic computer and typing skills. 4. Effective verbal communication skills and problem solving and conflict resolution ...

Briljent

Clinical Domain Project Manager (PBM)

Boston, MA · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Assigned projects span drug coverage administration, Preferred Drug List (PDL) management, prior authorization, utilization management, drug utilization review, clinical criteria configuration, and ...

Briljent

Clinical Domain Project Manager (PBM)

Boston, MA · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Assigned projects span drug coverage administration, Preferred Drug List (PDL) management, prior authorization, utilization management, drug utilization review, clinical criteria configuration, and ...

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All JobsUtilization Management JobsManager Utilization Management JobsManager Utilization Management Jobs in Boston, MA

Manager Utilization Management information

See Boston, MA salary details

$42.4K

$98.9K

$182K

How much do manager utilization management jobs pay per year?

As of Aug 16, 2026, the average yearly pay for manager utilization management in Boston, MA is $98,875.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,600.00 and $119,000.00 per year, depending on experience, location, and employer.

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 Boston, MA?

The most popular types of Utilization Management jobs in Boston, MA are:

What are popular job titles related to Manager Utilization Management jobs in Boston, MA?

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

What job categories do people searching Manager Utilization Management jobs in Boston, MA look for?

The top searched job categories for Manager Utilization Management jobs in Boston, MA are:

What cities near Boston, MA are hiring for Manager Utilization Management jobs?

Cities near Boston, MA with the most Manager Utilization Management job openings:

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Boston, MA as of August 2026, with employment types broken down into 1% As Needed, 81% Full Time, 14% Part Time, and 4% Contract. Highlights an 92% Physical, 3% Hybrid, and 5% Remote job distribution, with an average salary of $98,875 per year, or $47.5 per hour.

Senior Clinical Director, Medical Management

UMass Med School

Boston, MA • On-site

$170K/yr

Other

Posted 21 days ago

Job description

Senior Clinical Director, Medical Management
Minimum Salary US-MA-Boston
Job Location 3 weeks ago(7/22/2026 3:12 PM)
Requisition Number 2026-50362 # of Openings 1 Posted Date Day Shift Exempt Exempt/Non-Exempt Status Non Union Position -W60- Non Unit Professional Position Type Full-Time Min USD $140,000.00/Yr. Max USD $170,000.00/Yr.
Overview

The Senior Clinical Director for Medical Management will lead medical management strategy and operations for the MassHealth Office of Clinical Affairs to ensure the delivery of medically necessary, cost-effective, and high quality care for MassHealth members. Working closely with clinical and operational leaders within the Office of Clinical Affairs, this leader will oversee program initiatives related to utilization management (including prior authorizations), medical coverage policy, and care management.

Responsibilities

*Leads development and implementation of Office of Clinical Affairs strategy for medical management to ensure appropriate, efficient, and high quality care delivery
*Collects, analyzes and reports on medical management metrics to identify trends and recommend interventions
*Accountable to improving efficiency, cost-effectiveness, and quality in OCA's medical management programs, including through use of new technology as appropriate
*Contributes to MassHealth's cross-agency medical management strategy
*Oversees Office of Clinical Affairs Medical Management Programs and functions
*Oversees and contributes to OCA utilization management initiatives, including related to prior authorization, concurrent review, and retrospective review
*Oversees and contributes to development and implementation of clinical coverage policies, including assessment of new and existing technologies.
*Oversees and contributes to clinical reviews of providers
*Reviews, analyzes, and responds to quality and safety data
*Ensures high-performing medical management programs that adhere to all relevant regulatory and other requirements, including those set forth by CMS and other oversight entities
*Advises and collaborates with the Chief Medical Officer (CMO) and Medical/Clinical Directors on strategic issues involving medical management programs
*Serves as a lead interface for OCA medical management programs with other teams throughout the agency
*Leads and/or supports external stakeholder engagements regarding coverage and medical management of services for MassHealth members
*Manages clinical and non-clinical staff who are directly responsible for executing on OCA's medical management initiatives
*Ensures Medical Management staff maintain up-to-date knowledge, skills and abilities related to the administration of assigned responsibilities and functions
*Oversees relevant contractors performing utilization management reviews on behalf of OCA/MassHealth
*May engage in other clinical policies and program work within the MassHealth portfolio
*Other duties as assigned

Qualifications

LICENSURE/CERTIFICATION:
*Current, unrestricted R.N., C.N.P, or P.A. license in Massachusetts throughout employment with OCA
REQUIRED EDUCATION:
Bachelor's degree required
REQUIRED QUALIFICATIONS:
*At least 5 years experience in direct patient care
*At least 5 years experience in a leadership position in utilization/medical management in a managed care organization/health plan
*At least 5 years experience supervising clinical staff
*Thorough knowledge of the principles and practices of medical management including utilization management
*Excellent oral and written communication and presentation skills
*Must work 1-2 days per week on site in Boston and/or Quincy during normal business hours

Additional Information

PREFERRED QUALIFICATIONS:

*Demonstrated commitment to serving Medicaid patients
*Thorough knowledge of Medicaid and related regulations
*Certification in case management and/or utilization management

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