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Utilization Care Manager Jobs in Boston, MA (NOW HIRING)

Jobtailor

RN Care Manager

Revere, MA · On-site

$75 - $105/hr

Oversee utilization of long-term services and supports * Assist members with housing ... Adhere to NCQA and Care Management standards * Perform other job-related duties as requested ...

New

Equum Medical

Nurse Care Manager

Boston, MA · On-site

The Nurse Care Manager is a key member of the housing team working to support residents in living ... Ensure effective communication around changes in status, transitions, and service utilization.

Mass Digital Health

RN Utilization Review Jobs

Quincy, MA · On-site

$70 - $90/hr

Collaborates with business office, care managers, attending physicians, and physician advisors as ... Utilization Review experience (preferred). * Expected to work under minimal management supervision.

3M HEALTHCARE

Care Management Manager.

Boston, MA · On-site

$94.50 - $137/hr

Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement. * Understanding of pre‑acute and post‑acute ...

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All JobsUtilization Care JobsUtilization Care Manager JobsUtilization Care Manager Jobs in Boston, MA

Utilization Care Manager information

See Boston, MA salary details

$42.4K

$98.9K

$182K

How much do utilization care manager jobs pay per year?

As of Sep 6, 2026, the average yearly pay for utilization care manager 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 is a utilization care manager?

Utilization Care Managers are healthcare professionals responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They work to ensure that patients receive the right care at the right time, while also helping healthcare organizations manage costs and comply with regulations. Utilization Care Managers often review patient cases, coordinate with medical staff, and interact with insurance companies to authorize or deny services. Their goal is to optimize healthcare delivery, reduce unnecessary procedures, and improve patient outcomes.

How does a utilization care manager collaborate with medical and administrative teams to ensure effective patient care?

Utilization Care Managers work closely with physicians, nursing staff, and administrative teams to review patient cases, determine medical necessity, and coordinate appropriate care plans. They frequently participate in interdisciplinary meetings, communicate with insurance providers regarding authorizations, and ensure compliance with regulatory guidelines. This collaborative approach helps to optimize resource utilization, improve patient outcomes, and support smooth transitions of care. Being proactive in communication and documentation is key to success in this role.

What are the key skills and qualifications needed to thrive as a utilization care manager, and why are they important?

To thrive as a Utilization Care Manager, you need a background in healthcare, typically as a registered nurse or social worker, with expertise in care coordination and utilization review. Familiarity with utilization management software, medical necessity guidelines (such as Milliman or InterQual), and knowledge of insurance regulations are important. Strong analytical thinking, attention to detail, and effective communication skills help you advocate for patients while working with healthcare teams and payers. These skills ensure appropriate resource use, quality patient outcomes, and compliance with regulatory standards.

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

AspectUtilization Care ManagerUtilization Review Nurse
CredentialsRN, case management certificationRN, certification in utilization review
Work EnvironmentHealthcare facilities, insurance companiesHospitals, insurance companies, outpatient clinics
Primary FocusCoordinating patient care, managing resourcesReviewing medical necessity, approving treatments

Utilization Care Managers focus on coordinating patient care and managing resources, while Utilization Review Nurses primarily evaluate medical necessity for treatments. Both roles require nursing credentials and work within healthcare or insurance settings, but their core responsibilities differ in scope and focus.

What does a utilization care manager do in healthcare?

A utilization care manager in healthcare reviews patient cases to ensure appropriate use of medical services and resources, coordinating care plans to optimize patient outcomes and reduce unnecessary costs. They often work with healthcare providers, insurance companies, and patients, using data and clinical guidelines to make informed decisions about treatment and service utilization.

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

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

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

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

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

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

Utilization Care Manager jobs near you

RN Care Manager

Jobtailor

Revere, MA • On-site

$75 - $105/hr

Other

Posted 2 days ago

New

Job description

  • Provide monitoring, follow-up, and clinical care management to dually eligible enrollees with complex medical, behavioral, and social care needs
  • Engage enrollees in their homes and community settings to establish complex care management relationships
  • Consider members' cultural and linguistic needs
  • Liaise between healthcare providers, community resources, and enrollees to support communication and care transitions
  • Perform Comprehensive, MDS-HC or successor Functional, and Crisis and Risk Assessments
  • Develop and implement care plans with enrollees and provide routine updates
  • Lead interdisciplinary care teams and collaborate with internal and external peers
  • Oversee utilization of long-term services and supports
  • Assist members with housing, transportation, food assistance, and social services
  • Educate members about Medicare, Medicaid, benefits, chronic condition management, medication adherence, and preventive care
  • Promote healthy lifestyles and self-management strategies
  • Support preventive health strategies and gap closure
  • Follow up after hospitalizations or significant health events to support continuity and prevent readmissions
  • Coordinate care with primary care physicians, specialists, healthcare providers, community organizations, state agencies, and service providers
  • Advocate for enrollee needs and preferences
  • Evaluate member satisfaction and monitor concerns
  • Conduct regular member, provider, and community-based visits, with travel potentially exceeding 50% of work time
  • Report abuse, neglect, or exploitation as a mandated reporter under state law
  • Adhere to NCQA and Care Management standards
  • Perform other job-related duties as requested
Requirements
  • Associate of Science (A.S.) degree in nursing from an accredited nursing program required
  • Registered Nurse with ability to independently serve people with complex medical, behavioral, and social needs
  • Current unrestricted clinical license in the Commonwealth of Massachusetts as a Registered Nurse (RN) required
  • Intermediate proficiency with Microsoft Office, including Outlook, Word and Excel
  • Understanding of Medicare and Medicaid programs and community resources for dual-eligible beneficiaries
  • Strong interpersonal, communication, customer relations, and customer service skills
  • Ability to manage multiple cases and priorities while maintaining attention to detail
  • Ability to function independently and effectively as part of an interdisciplinary team
  • Current valid driver's license, vehicle, and verifiable insurance
  • Successful driver's license record check required
  • Annual Influenza vaccination required during Influenza season
  • Must reside in the assigned territory and within commutable distance to the Commonwealth of Massachusetts
  • Prior experience in care coordination, case management, or working with dual-eligible populations preferred
  • Medicaid and/or Medicare managed care experience preferred
  • Clinical Field/Community Based Training a plus
  • Case Management Certification highly preferred
Core Competencies

Demonstrates expertise in care management for dually eligible enrollees, focusing on complex medical, behavioral, and social needs. Proficient in developing care plans, conducting assessments, and collaborating with interdisciplinary teams to ensure effective communication and continuity of care.

Highest-signal resume keywords
  • Registered Nurse (RN)
  • Care Coordination
  • Medicare and Medicaid Knowledge
  • Case Management Certification
  • Interdisciplinary Team Collaboration
Hard Skills
  • Comprehensive Assessments
  • Crisis and Risk Assessments
  • Care Plan Development
  • Utilization Management
  • Medication Adherence Education
Soft Skills
  • Interpersonal Skills
  • Communication Skills
  • Customer Service Skills
  • Attention to Detail
  • Independent Functioning
Certifications & Qualifications
  • Registered Nurse License
  • Case Management Certification
  • Annual Influenza Vaccination
Industry Keywords
  • Dually Eligible Populations
  • Community Resources
  • Health Care Transitions
  • Preventive Health Strategies
  • NCQA Standards
Tools & Technologies
  • Microsoft Office
  • Outlook
  • Word
  • Excel
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