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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

$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 ...

Lancesoft INC

Case Management (RN)

Milford, MA · On-site

$3.0K - $3.1K/wk

... Manager Duration: 13 weeks Shift: M-F, 40hr days, 8hr/day, Occasional weekend & Holidays Requirements: BSN required Active MA state RN license required 3+ yr of Hospital Case management & Utilization ...

Tenet Health

Director of Case Management

Worcester, MA · On-site

$118K - $183K/yr

Utilization Management supporting medical necessity and denial prevention; Transition Management ... Experience: 3 years of acute hospital case management or healthcare leadership experience

Tenet Health

Director of Case Management

Worcester, MA · On-site

Accredited Case Manager (ACM) * Manage department operations to assure effective throughput and reimbursement for services provided * Lead the implementation and oversight of the hospital Utilization ...

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Utilization Case Manager information

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How much do utilization case manager jobs pay per hour?

As of Jul 28, 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 does a utilization case manager do?

A utilization case manager reviews and authorizes healthcare services to ensure they are necessary and appropriate, often working with insurance companies and healthcare providers. They analyze patient records, coordinate care plans, and ensure compliance with policies, typically using case management software and requiring strong communication skills.

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 jobs pay 4000 a week without a degree?

Utilization Case Managers typically do not earn $4,000 weekly without relevant experience or certifications; most roles in healthcare or social services pay less. High-paying jobs that can reach this level without a degree are rare and often involve specialized skills, sales, or entrepreneurship. Generally, achieving such income without a degree requires significant experience, licensing, or working in high-demand fields like real estate or certain trades.

What is the highest paid case manager?

The highest paid case managers are often those with advanced certifications, specialized skills, or experience in high-demand fields such as healthcare or insurance. Senior or managerial roles, such as Utilization Review Managers, can earn salaries exceeding $80,000 to $100,000 annually. Compensation varies based on location, industry, and level of responsibility.

Is being a MOA a good entry level job?

A Medical Office Assistant (MOA) role is often considered an entry-level position in healthcare, requiring basic administrative and clinical skills. It provides experience with medical records, patient communication, and office procedures, which can serve as a foundation for advancing in healthcare careers. However, the job's suitability depends on individual career goals and the specific workplace environment.

What are the key skills and qualifications needed to thrive as a Utilization Case Manager, and why are they important?

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.

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 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
Case Manager - Nursing - Travel

Case Manager - Nursing - Travel

Lighthouse Medical Staffing

Milford, MA

$2.8K - $3.0K/wk

Other

Posted 16 days ago

Job description

Job Description Case Manager - Nursing - Travel Location: Milford, MA Job Description: Join a dynamic nursing team as a Case Manager, where your expertise will be essential in providing top-notch care to patients. In this collaborative role, you'll facilitate comprehensive management for an assigned group of individuals, ensuring a seamless and individualized experience that prioritizes their discharge needs and overall well-being. This position offers the opportunity to work with a dedicated healthcare team while utilizing your skills in utilization review, making a real impact in the lives of patients.

If you're a motivated RN with a BSN and a passion for case management, we'd love to hear from you. Requirements: BSN current Massachusetts RN license 3 years of prior hospital Case Management experience Utilization Review experience If you are a qualified Case Manager and looking for an exciting contract position with competitive compensation and benefits packages, apply today. Job ID: 870-516 Profession: Case Manager Specialty: Nursing City: Milford State: MA Employment Type: Travel Contract Duration: 13 weeks Shift: Days 5x8 Total Weekly Comp: $2,859 - $3,045.

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About Lighthouse Medical Staffing

Sourced by ZipRecruiter

Lighthouse Medical Staffing was established in 2017 with the purpose of revolutionizing the healthcare industry, making it more efficient and responsive. We offer a full range of recruitment services to assist healthcare organizations in achieving their employment objectives and selecting the most suitable applicants at all levels, from interns to executives. We collaborate closely with your internal departments to quickly expand capacity, allowing you to hire additional, dedicated employees who can make an immediate impact. A large number of well-educated, healthcare professionals are part of our worldwide network and are looking for their next opportunity. Our mission is to utilize our cutting edge technologies, personalized service and industry partners to connect talented healthcare clinicians with incredible opportunities the healthcare industry. At Lighthouse Medical Staffing, we foster a positive environment and develop close relationships with our clients that keeps them coming back to us when outsourcing their HR responsibilities. Being experienced recruiters, we understand the challenges most individuals face during job hunting and strive to make their vocation searching process easier and quick. Our team of talent healthcare specialists has filled thousands of roles in a variety of healthcare facilities, ranging from entry-level employment to senior executive positions. We’ve helped hospitals and clinics find excellent candidates while also delivering beneficial career solutions to in-demand job applicants along the way.

Industry

Recruiting and staffing services

Company size

11 - 50 Employees

Headquarters location

Carmel, IN, US

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