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Remote Utilization Management Jobs in Boston, MA

BMC HealthNet Plan

Medical Director

Boston, MA · On-site +1

$173K - $250K/yr

... utilization trend management, quality, appeals and grievances, and pharmacy reviews. Our Investment in You: • Full-time remote work • Competitive salaries • Excellent benefits Key Functions ...

WellSense Health Plan

Medical Director

MA · On-site +1

$173K - $250K/yr

... utilization trend management, quality, appeals and grievances, and pharmacy reviews. Our Investment in You: · Full-time remote work · Competitive salaries · Excellent benefits Key Functions ...

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

Remote Utilization Management information

See Boston, MA salary details

$23

$45

$74

How much do remote utilization management jobs pay per hour?

As of Jul 20, 2026, the average hourly pay for remote utilization management in Boston, MA is $45.94, according to ZipRecruiter salary data. Most workers in this role earn between $36.30 and $52.74 per hour, depending on experience, location, and employer.

How does a Remote Utilization Management professional typically collaborate with healthcare providers and insurance teams?

Remote Utilization Management professionals frequently interact with both healthcare providers and insurance teams through secure digital platforms, phone calls, and virtual meetings. They review patient records, assess the necessity of medical services, and communicate their recommendations or authorization decisions. Effective collaboration requires clear documentation, timely responses, and strong communication skills to ensure that care is both medically appropriate and cost-effective. While the work is often independent, regular coordination with interdisciplinary teams is essential for maintaining high-quality patient outcomes and adhering to regulatory standards.

What are the key skills and qualifications needed to thrive as a Remote Utilization Management Nurse, and why are they important?

Success as a Remote Utilization Management Nurse requires a registered nursing license, clinical experience, and strong knowledge of medical necessity criteria and insurance guidelines. Familiarity with utilization review software, electronic health records (EHRs), and case management systems is typically necessary. Exceptional communication, critical thinking, and organizational skills help professionals excel in evaluating cases and coordinating with providers remotely. These skills are crucial for ensuring appropriate care, cost-effective resource use, and regulatory compliance in a remote healthcare setting.

What is remote utilization management?

Remote utilization management is a process in which healthcare professionals, such as nurses or case managers, review and assess the necessity, efficiency, and appropriateness of medical services—often from a remote location. These professionals typically work for insurance companies, hospitals, or healthcare organizations to ensure that patients receive the right care while controlling costs. By working remotely, they use electronic health records, phone calls, and other digital tools to collaborate with providers and patients. This role helps improve healthcare quality and cost-effectiveness while allowing employees flexible work arrangements.

What is the difference between Remote Utilization Management vs Remote Case Management?

AspectRemote Utilization ManagementRemote Case Management
CredentialsRN, LPN, or licensed healthcare professionalsRN, LPN, or social workers
Work EnvironmentHealthcare facilities, insurance companies, telehealthHealthcare providers, insurance, community agencies
Industry UsageInsurance, healthcare, telehealthHealthcare, social services, insurance
Primary FocusReviewing medical necessity, authorizationsCoordinating patient care, support services

Remote Utilization Management primarily involves reviewing medical necessity and authorizations, while Remote Case Management focuses on coordinating patient care and support services. Both roles require healthcare credentials and are used within healthcare and insurance industries, but they serve different functions in patient care and resource allocation.

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 Remote Utilization Management jobs in Boston, MA? For Remote Utilization Management jobs in Boston, MA, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Management jobs in Boston, MA look for? The top searched job categories for Remote Utilization Management jobs in Boston, MA are:
What cities near Boston, MA are hiring for Remote Utilization Management jobs? Cities near Boston, MA with the most Remote Utilization Management job openings:
Remote Utilization Management jobs near you
Infographic showing various Remote Utilization Management job openings in Boston, MA as of July 2026, with employment types broken down into 1% As Needed, 78% Full Time, 18% Part Time, 1% Temporary, and 2% Contract. Highlights an 87% Physical, 3% Hybrid, and 10% Remote job distribution, with an average salary of $95,545 per year, or $45.9 per hour.
Senior AI & Utilization Management Product Manager

Senior AI & Utilization Management Product Manager

Newfire Global Partners

Boston, MA • On-site, Remote

$150K - $181K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 23 days ago

Job description

Senior AI & Utilization Management Product Manager
Department: Product Management
Employment Type: Full Time
Location: US
Compensation: $150,000 - $181,000 / year
Description
Job Title: Senior AI & Utilization Management Product Manager
Track: Individual Contributor (IC)
Experience: 7 - 10 years
Department: Product Management
Location: Care Lumen | Remote (US Only)
Reports to: Director, Product Management
Salary Range: $150000 - $181000
Bonus (if applicable): 10%
Scope
We're seeking an experienced Senior Product Manager to drive innovation in our Utilization Management (UM) platform, with a specific focus on leveraging AI technology to transform how clinicians perform medical necessity reviews. You'll own the product strategy and roadmap for our member clinical documentation system, working to dramatically reduce administrative burden while maintaining clinical quality and compliance. This role translates complex healthcare needs into scalable, secure, and compliant solutions that support real-world care and operations. The role is expected to operate with high autonomy, manage complex problem spaces, and apply strong product judgment to navigate ambiguity and trade-offs.
Serving as a strategic owner and connector, the Senior Product Manager drives clarity and alignment across teams and partners with leadership to ensure product priorities support organizational goals. This is an individual contributor role with significant cross-functional influence.
Key Responsibilities
  • Define and evolve product roadmaps, requirements, and success metrics grounded in user insights, healthcare domain understanding, and data
  • Lead discovery and delivery efforts that translate validated user needs into meaningful clinical, operational, and customer outcomes
  • Drive the integration of AI/ML capabilities to automate clinical documentation extraction, summarization, and decision support
  • Collaborate with data science and engineering teams to develop and refine AI models that assist with medical necessity determinations
  • Design intelligent workflows that surface relevant clinical information and reduce manual chart review time
  • Evaluate emerging AI technologies and vendors to inform build-vs-buy decisions
  • Own product direction and the end-to-end lifecycle for a major product line or module from discovery through delivery and outcome measurement
  • Drive cross-functional alignment by clarifying goals, framing trade-offs, and grounding decisions in data across engineering, design, and partner teams
  • Measure and optimize product performance by defining KPIs, monitoring results, and iterating based on insights and feedback
  • Partner closely with Customer Support, Implementation teams, and Clinical SMEs to support adoption, usability, and customer outcomes
  • Identify and advance opportunities for improvement and innovation informed by customer needs, market trends, and evolving healthcare models
  • Model strong product practices and elevate execution quality through influence, feedback, and shared standards.

Skills, Knowledge & Expertise
  • 7-10 years of product management experience, including ownership of complex product areas in health tech, healthcare IT, or similarly regulated domains
  • Demonstrated ability to own and deliver products end-to-end in complex, regulated environments, from discovery through launch and iteration
  • Strong understanding of healthcare ecosystems, including clinical workflows, customer segments, and regulatory context
  • Proven experience applying hypothesis-driven discovery and outcome-oriented development to drive meaningful product decisions
  • Deep familiarity with healthcare security, privacy, and compliance standards, and experience embedding these considerations throughout the product lifecycle
  • Strong product judgment and analytical skills, with the ability to translate domain complexity into clear priorities, trade-offs, and measurable outcomes
  • Excellent communication and stakeholder leadership skills, with a track record of influencing cross-functional teams without direct authority
  • Experience working closely with cross-functional teams including Engineering, Design, Data, and customer-facing partners in fast-paced environments
  • Experience building SaaS products in healthcare, with exposure to analytics, AI-enabled features, or population health solutions preferred

Preferred
  • Familiarity with regulatory requirements (NCQA UM standards, state regulations, CMS guidelines)
  • Experience with HIPAA-compliant AI implementations and healthcare data governance

Compensation & Benefits
Compensation & Benefits
The expected total cash compensation for this role is market-driven, with an expected starting salary of $150,000 - $181,000. Salary is ultimately determined based on a candidate's skills, expertise, and experience.
Care Lumen offers a robust and comprehensive benefits package including:
  • Remote-first environment with company provided computer
  • Thirteen paid holidays per year (average)
  • Medical, dental and vision coverage with multiple levels of coverage
  • HSA, FSA and Dependent Care accounts
  • Short-term and Long-term disability
  • Life and accidental death insurance
  • Discounted voluntary benefits, such as additional life insurance
  • Employee Assistance Program
  • Paid Parental Leave
  • Flexible vacation time
  • 401(k) with employer matching and immediate vesting

Offers are contingent upon successful completion of a background screening. Background screenings will be conducted in compliance with applicable laws and will not be initiated without your consent.
Care Lumen is an equal opportunity employer committed to building a diverse and inclusive workplace. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other legally protected status.
We are committed to providing reasonable accommodations to qualified individuals with disabilities in our job application process. If you need assistance or an accommodation due to a disability, please contact us at apply@carelumen.com.
About Care Lumen
Care Lumen is transforming healthcare by connecting people, care, and data-so that every decision leads to better outcomes. We empower care teams with a unified platform that delivers intelligent, real-time insights, streamlined workflows, and stronger collaboration across clinical, operational, and administrative domains.
Our vision is bold: to reimagine how care is delivered by unifying clinical operations and unlocking insights that improve lives. We believe in the power of great people and purposeful technology-and with all of us aligned around a common goal, our potential grows even stronger. We're building for impact today and evolving through innovation tomorrow.
We're a remote-first company that values flexibility, autonomy, and results over hours logged. We're guided by values that push us to excel, stay curious, and take smart risks. The best solutions come from teams that listen, learn, and build together. And we're focused on outcomes that matter-not just for our clients, but for the people they serve.
Care Lumen's LinkedIn
Care Lumen's website
Process - What to Expect
Our hiring process typically includes:
  1. Applied
  2. Recruiter Interview
  3. Hiring Manager Interview
  4. Second Hiring Manager Interview
  5. Panel Interview
  6. Second Panel Interview
  7. Offer
  8. Background Check
  9. Hired - Welcome to Care Lumen!

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