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Manager Utilization Management Jobs in Cambridge, MA

US Tech Solutions

Utilization Review Nurse

Canton, MA · On-site

$55 - $60/hr

The ideal candidate will have a strong background in managed care, utilization management, medical necessity review, prior authorization, and outpatient clinical review. This role is responsible for ...

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

Manager Utilization Management information

See Cambridge, MA salary details

$42.6K

$99.5K

$183.1K

How much do manager utilization management jobs pay per year?

As of Sep 6, 2026, the average yearly pay for manager utilization management in Cambridge, MA is $99,473.00, according to ZipRecruiter salary data. Most workers in this role earn between $65,000.00 and $119,700.00 per year, depending on experience, location, and employer.

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 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 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 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 popular job titles related to Manager Utilization Management jobs in Cambridge, MA?

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

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

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

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

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

Manager Utilization Management jobs near you
Infographic showing various Manager Utilization Management job openings in Cambridge, MA as of August 2026, with employment types broken down into 76% Full Time, and 24% Contract. Highlights an 100% In-person job distribution, with an average salary of $99,473 per year, or $47.8 per hour.

Utilization Management RN

VitalCore Health Strategies

Hopkinton, MA • On-site

$100K - $110K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 2 days ago

New

VitalCore Health Strategies rating

5.6

Company rating: 5.6 out of 10

Based on 13 frontline employees who took The Breakroom Quiz

Job description

 

VitalCore Health Strategies, (VCHS), an industry leader in Correctional Healthcare, has a Full-Time opening for a Utilization Management RN at the Regional Office in Hopkinton, MA!!!
 

Start A New Career with VitalCore Health Strategies!

At VitalCore we pride ourselves on retaining and acquiring hardworking ethical individuals who are committed to providing quality services. Join our team and experience first-hand how VitalCore Health Strategies promotes a positive work environment that is based on respect and appreciation of the hard work and dedication of our staff.


UTILIZATION MANAGEMENT RN - ESSENTIAL FUNCTIONS 

  • Essentially will serve as a Regional Office Case Manager for an incarcerated population, advocating for optimum healthcare
  • Maintain accurate, detailed reports and confidential records
  • Consult and coordinate with healthcare team members to assess, plan, implement, or evaluate patient care plans
  • Modify patient treatment plans as indicated by patients’ responses and conditions
  • Review all aspects of facility patient care
  • Review referrals for offsite treatment and care for appropriateness and best utilization of resources
  • Performing as a Liaison with all offsite providers, both specialty as well as hospitals
  • Review medical transports to Emergency Departments to ensure continuity of care
  • Overseeing hospitalized cases, to include reviewing daily clinicals and providing information to facility MD and team
  • Assisting with hospital discharge planning to ensure goals of care are met
  • Seeking infirmary level bed placement when care is needed on a higher level
  • Additional duties as assigned by regional office

MINIMUM REQUIREMENTS / PREFERENCES

  • Graduate of an accredited School of Nursing
  • Licensure as a Registered Nurse in the state of employment with 1+ years of experience or as an LPN with 5+ years of experience
  • Preferred experience in Med Surg, Case Management, and/or Discharge Planning
  • Possesses an active CPR certification
  • Remains knowledgeable about specific state laws and regulations governing practice
  • Satisfactory completion of initial and annual clinical competencies to demonstrate aptitude as assigned by role

We’re people who are fueled by passion, not by profit. 

GENEROUS BENEFITS PACKAGE:

Holiday Pay: New Year’s Day, Martin Luther King Jr. Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Veteran’s Day, Thanksgiving Day, and Christmas Day

  • Medical/Dental/Vision Insurance
  • Life Insurance
  • Short Term/Long Term Disability
  • Identity Theft Protection
  • Animal/Pet Insurance
  • Employee Assistance Program and Discount Center
  • 401K
  • EEO 

Keywords: Utilization Management, RN, Nurse, Administrative, #INDMA

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