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Utilization Management Jobs in Dedham, MA (NOW HIRING)

Tenet Health

Director - Case Management

Worcester, MA · On-site

$118K - $183K/yr

Utilization Management supporting medical necessity and denial prevention; Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction; Care ...

WellSense Health Plan

Medical Director

MA · On-site +1

$173K - $250K/yr

The Medical Director will report to the Senior Medical Director of Utilization Management, Member Appeals & Grievances, and Medical Policy (Senior Medical Director of Utilization Management) and ...

STI

Case Manager - Registered Nurse

Cambridge, MA · On-site

... Utilization Management Committees to accurately determine appropriateness for inpatient and outpatient care. 3. Communicates with attending and house staff when options to inpatient care are ...

BMC HealthNet Plan

Medical Director

Boston, MA · On-site +1

$173K - $250K/yr

The Medical Director will report to the Senior Medical Director of Utilization Management, Member Appeals & Grievances, and Medical Policy (Senior Medical Director of Utilization Management) and ...

STI

Case Manager - Registered Nurse

Cambridge, MA · On-site

... Utilization Management Committees to accurately determine appropriateness for inpatient and outpatient care. 3. Communicates with attending and house staff when options to inpatient care are ...

Superbeo

RN-Case Manager

Cambridge, MA · On-site

Two years of case management or utilization management experience required. 3. Basic computer and typing skills. 4. Effective verbal communication skills and problem solving and conflict resolution ...

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All JobsUtilization Management JobsUtilization Management Jobs in Dedham, MA

Utilization Management information

See Dedham, MA salary details

$40.1K

$91.9K

$167.4K

How much do utilization management jobs pay per year?

As of Aug 23, 2026, the average yearly pay for utilization management in Dedham, MA is $91,917.00, according to ZipRecruiter salary data. Most workers in this role earn between $66,300.00 and $107,300.00 per year, depending on experience, location, and employer.

What is utilization management?

A Utilization Management (UM) job involves evaluating medical services to ensure they are necessary, cost-effective, and compliant with healthcare guidelines. Professionals in this field review patient care plans, authorize treatments, and collaborate with healthcare providers to optimize resource use. They work for insurance companies, hospitals, or healthcare organizations to balance quality care with cost control. Strong analytical skills and knowledge of medical policies are essential in this role.

What are the typical daily responsibilities of a utilization management professional?

As a Utilization Management professional, your day-to-day duties typically include reviewing patient admissions, authorizing ongoing treatment or procedures, assessing medical necessity, and ensuring services comply with insurance policies and industry guidelines. You will frequently collaborate with physicians, nurses, and insurance representatives to facilitate timely and appropriate care decisions while managing cost and quality. Documentation and communication play key roles as you help bridge the gap between clinical teams and payers. This role is often fast-paced, requires decisive action, and provides opportunities to have a direct impact on patient outcomes and organizational efficiency.

What are the key skills and qualifications needed to thrive in utilization management, and why are they important?

To thrive in Utilization Management, you need a strong understanding of healthcare procedures, insurance guidelines, and case review processes, usually backed by a clinical background such as RN, LPN, or allied health certification. Familiarity with medical management software, electronic health records (EHR), and utilization review tools like InterQual or MCG is often required. Excellent analytical thinking, attention to detail, and effective communication skills greatly enhance performance in this role. These competencies enable accurate assessment of medical necessity, ensure regulatory compliance, and support efficient, collaborative workflows between providers, insurers, and patients.

What degree is needed for utilization management?

Utilization management professionals typically need at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Some roles may require a master's degree or professional certifications such as Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Experience in healthcare settings and knowledge of medical terminology and insurance processes are also important.

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

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

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

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

Utilization Management jobs near you
Infographic showing various Utilization Management job openings in Dedham, MA as of August 2026, with employment types broken down into 1% As Needed, 79% Full Time, 16% Part Time, 2% Temporary, and 2% Contract. Highlights an 84% Physical, 3% Hybrid, and 13% Remote job distribution, with an average salary of $91,917 per year, or $44.2 per hour.

Sr Clin. Dir, Medical Mgmt

University of Massachusetts Medical School

Boston, MA • On-site

$140K - $170K/yr

Full-time

Re-posted 2 days ago

Job description

Overview
The Senior Clinical Director for Medical Management will lead medical management strategy and operations for the MassHealth Office of Clinical Affairs to ensure the delivery of medically necessary, cost-effective, and high quality care for MassHealth members. Working closely with clinical and operational leaders within the Office of Clinical Affairs, this leader will oversee program initiatives related to utilization management (including prior authorizations), medical coverage policy, and care management.
Responsibilities
• Leads development and implementation of Office of Clinical Affairs strategy for medical management to ensure appropriate, efficient, and high quality care delivery
• Collects, analyzes and reports on medical management metrics to identify trends and recommend interventions
• Accountable to improving efficiency, cost-effectiveness, and quality in OCA's medical management programs, including through use of new technology as appropriate
• Contributes to MassHealth's cross-agency medical management strategy
• Oversees Office of Clinical Affairs Medical Management Programs and functions
• Oversees and contributes to OCA utilization management initiatives, including related to prior authorization, concurrent review, and retrospective review
• Oversees and contributes to development and implementation of clinical coverage policies, including assessment of new and existing technologies.
• Oversees and contributes to clinical reviews of providers
• Reviews, analyzes, and responds to quality and safety data
• Ensures high-performing medical management programs that adhere to all relevant regulatory and other requirements, including those set forth by CMS and other oversight entities
• Advises and collaborates with the Chief Medical Officer (CMO) and Medical/Clinical Directors on strategic issues involving medical management programs
• Serves as a lead interface for OCA medical management programs with other teams throughout the agency
• Leads and/or supports external stakeholder engagements regarding coverage and medical management of services for MassHealth members
• Manages clinical and non-clinical staff who are directly responsible for executing on OCA's medical management initiatives
• Ensures Medical Management staff maintain up-to-date knowledge, skills and abilities related to the administration of assigned responsibilities and functions
• Oversees relevant contractors performing utilization management reviews on behalf of OCA/MassHealth
• May engage in other clinical policies and program work within the MassHealth portfolio
• Other duties as assigned
Qualifications
LICENSURE/CERTIFICATION:
• Current, unrestricted R.N., C.N.P, or P.A. license in Massachusetts throughout employment with OCA
REQUIRED EDUCATION:
Bachelor's degree required
REQUIRED QUALIFICATIONS:
• At least 5 years experience in direct patient care
• At least 5 years experience in a leadership position in utilization/medical management in a managed care organization/health plan
• At least 5 years experience supervising clinical staff
• Thorough knowledge of the principles and practices of medical management including utilization management
• Excellent oral and written communication and presentation skills
• Must work 1-2 days per week on site in Boston and/or Quincy during normal business hours
Additional Information
PREFERRED QUALIFICATIONS:
• Demonstrated commitment to serving Medicaid patients
• Thorough knowledge of Medicaid and related regulations
• Certification in case management and/or utilization management
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