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Utilization Case Manager Jobs in Worcester, MA (NOW HIRING)

Encompass Health

Case Manager

Worcester, MA

$20 - $25.75/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Encompass Health

Case Manager

Ludlow, MA

$21 - $27/hr

Participate in utilization review process: data collection, trend review, and resolution actions. * Participate in case management on-call schedule as needed. Qualifications * License or ...

Lancesoft INC

RN Case Manager

Milford, MA · On-site

$3.0K - $3.1K/wk

BSN required Active MA state RN license required 3+ yr of Hospital Case management & Utilization review required BLS (AHA) Company Description LanceSoft is rated as one of the largest staffing firms ...

American Addiction Centers

Case Manager

Worcester, MA · On-site

$20 - $25.75/hr

The Case Manager will actively participate in the Treatment team, coordinate services for patients as needed, and serve as an advocate by communicating with the Utilization Review (UR) department ...

American Addiction Centers

Case Manager

Worcester, MA · On-site

$20 - $25.75/hr

The Case Manager will actively participate in the Treatment team, coordinate services for patients as needed, and serve as an advocate by communicating with the Utilization Review (UR) department ...

American Addiction Centers

Case Manager

Worcester, MA · On-site

$20 - $25.75/hr

The Case Manager will actively participate in the Treatment team, coordinate services for patients as needed, and serve as an advocate by communicating with the Utilization Review (UR) department ...

American Addiction Centers

Case Manager

Worcester, MA · On-site

$20 - $25.75/hr

The Case Manager will actively participate in the Treatment team, coordinate services for patients as needed, and serve as an advocate by communicating with the Utilization Review (UR) department ...

American Addiction Centers

Case Manager

Worcester, MA · On-site

$20 - $25.75/hr

The Case Manager will actively participate in the Treatment team, coordinate services for patients as needed, and serve as an advocate by communicating with the Utilization Review (UR) department ...

American Addiction Centers

Case Manager

Worcester, MA · On-site

$20 - $25.75/hr

The Case Manager will actively participate in the Treatment team, coordinate services for patients as needed, and serve as an advocate by communicating with the Utilization Review (UR) department ...

American Addiction Centers

Case Manager

Worcester, MA · On-site

$20 - $25.75/hr

The Case Manager will actively participate in the Treatment team, coordinate services for patients as needed, and serve as an advocate by communicating with the Utilization Review (UR) department ...

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Utilization Case Manager information

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How much do utilization case manager jobs pay per hour?

As of Aug 27, 2026, the average hourly pay for utilization case manager in Worcester, MA is $36.41, according to ZipRecruiter salary data. Most workers in this role earn between $29.52 and $38.37 per hour, depending on experience, location, and employer.

What is a utilization case manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

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

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

How does a utilization case manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

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

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What degree do I need for utilization case manager?

Utilization case managers typically need at least a bachelor's degree in healthcare, social work, nursing, or a related field. Some positions may prefer or require a master's degree or relevant certifications, such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ).

What are popular job titles related to Utilization Case Manager jobs in Worcester, MA?

For Utilization Case Manager jobs in Worcester, MA, the most frequently searched job titles are:

What job categories do people searching Utilization Case Manager jobs in Worcester, MA look for?

The top searched job categories for Utilization Case Manager jobs in Worcester, MA are:

What cities near Worcester, MA are hiring for Utilization Case Manager jobs?

Cities near Worcester, MA with the most Utilization Case Manager job openings:

Utilization Case Manager jobs near you

RN Nurse Case Manager (Per Diem)

Mass General Brigham (Enterprise Services)

Newton, MA • On-site

Other

Posted 14 days ago

Brigham and Women's Hospital rating

8.1

Company rating: 8.1 out of 10

Based on 101 frontline employees who took The Breakroom Quiz

117th of 1,064 rated hospitals

Job description

Site: Mass General Brigham Incorporated

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

Per diem shifts will be variable (Day shift Monday through Friday, holidays and weekends).
The essential duties of the Insurance Support-Utilization Case Manager are to act as the department coordinator for all insurance workflows that case managers are responsible for; be the department point person for managing and preventing denials and the department expert for understanding payer rules and regulations. The Insurance support- Utilization Case Manager works closely with care coordination, medical and surgical physicians, nursing staff and other PHS departments that are responsible for billing, compliance, and finance and revenue integrity.
Key areas of responsibilities include managing day to day payer communication as it relates to supporting hospital admissions; providing UR to payers as needed; managing complex billing decisions; identifying payer trends; responding to payer denials; interfacing with other departments that impact billing and denials; educating care coordination staff about utilization management issues, government regulations and other things that impact revenue integrity; and providing reports related to UM as needed.

Qualifications

Qualifications:

  • Associate's Degree Nursing required or Bachelor's Degree Nursing preferred.

  • Registered Nurse (RN) License for the State of Massachustetts required.

  • 3+ years of Medical Surgical experience required.

  • Utilization Review (UR) experience strongly preferred.

Additional Skills for Success:

  • Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.

  • Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.

  • Ability to establish strong rapport and relationships with patients and staff.

  • Proficient in Microsoft Office and industry related software programs.

  • Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.

  • Ability to maintain client and staff confidentiality.

  • Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care.

  • Knowledge of Healthcare and Managed Care preferred.

Additional Job Details (if applicable)

Working Model and Schedule:

  • Fully remote

  • Per Diem shifts will be variable (Days Monday through Friday, holidays and weekends). Must be available to work at least 8 hours per week and will not work more than 24 hours per week.

  • A quiet, secure, compliant work station is required for remote employees, using MGB Issues equipment.

  • This role requires employee to reside in New England states (CT, MA, ME, NH, RI, VT) to be eligible for employment at Newton Wellesley Hospital and for this Union position.

Remote Type

Remote

Work Location

2014 Washington Street

Scheduled Weekly Hours

0

Employee Type

Per Diem

Work Shift

Day (United States of America)

Pay Range

- /Hourly

Grade

RN2600 At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

0100 Mass General Brigham Incorporated is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642. Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership "looks like" by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

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