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Utilization Manager Jobs in Boston, MA (NOW HIRING)

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 ...

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 ...

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All JobsUtilization JobsUtilization Manager JobsUtilization Manager Jobs in Boston, MA

Utilization Manager information

See Boston, MA salary details

$42.4K

$98.9K

$182K

How much do utilization manager jobs pay per year?

As of Aug 12, 2026, the average yearly pay for utilization manager in Boston, MA is $98,870.00, 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 are the key skills and qualifications needed to thrive as a utilization manager?

To thrive as a Utilization Manager, you need a solid background in healthcare management, case review, and knowledge of insurance regulations, often supported by a degree in nursing, healthcare administration, or a related field. Familiarity with utilization management software, electronic health records (EHRs), and certification such as Certified Case Manager (CCM) are typically required. Strong analytical thinking, communication, and negotiation skills help Utilization Managers effectively coordinate care and collaborate with providers. These skills ensure appropriate resource use, regulatory compliance, and optimal patient outcomes within healthcare organizations.

What are some common challenges faced by utilization managers, and how can they be addressed?

Utilization Managers often face challenges such as balancing cost containment with patient care quality, navigating complex insurance policies, and managing high caseloads. To address these, effective communication with healthcare providers and payers is essential, as is staying current with regulatory requirements and best practices. Building strong relationships within interdisciplinary teams and leveraging data analytics tools can also help Utilization Managers make informed decisions and improve workflow efficiency.

What is a utilization manager?

A utilization manager works in the insurance industry to analyze health care needs in medical cases and determine further patient care. In this career, your job duties include conducting interviews to determine what services you register for and cutting down on unnecessary costs. You may review medical records and compile documentation to improve care and report your findings. Skills in management, customer service, and health care services are vital in this career. Job experience in nursing is a benefit when applying for utilization manager positions. Additional qualifications include a bachelor’s degree and medical case management certificate.

What is the difference between Utilization Manager vs Utilization Coordinator?

AspectUtilization ManagerUtilization Coordinator
CertificationsOften requires healthcare or case management certificationsMay have similar certifications but less emphasis on management
Work EnvironmentTypically in healthcare organizations, overseeing utilization review processesSupports daily operations, assisting with case documentation and scheduling
Employer & Industry UsageCommon in healthcare, insurance, and managed care companiesFound in similar settings, often working under Utilization Managers

In summary, a Utilization Manager generally has broader responsibilities, overseeing utilization review and resource allocation, while a Utilization Coordinator focuses on supporting daily tasks and documentation. Both roles are integral in healthcare settings but differ in scope and level of responsibility.

More about Utilization Manager jobs
What are popular job titles related to Utilization Manager jobs in Boston, MA? For Utilization Manager jobs in Boston, MA, the most frequently searched job titles are:
What job categories do people searching Utilization Manager jobs in Boston, MA look for? The top searched job categories for Utilization Manager jobs in Boston, MA are:
What cities near Boston, MA are hiring for Utilization Manager jobs? Cities near Boston, MA with the most Utilization Manager job openings:
Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Boston, MA as of August 2026, with employment types broken down into 100% Full Time. Highlights an 74% In-person, and 26% Remote job distribution, with an average salary of $98,870 per year, or $47.5 per hour.

Sr. Med Dir, Med Mgmt

University of Massachusetts Medical School

Boston, MA • On-site

$220K - $260K/yr

Full-time

Re-posted 17 days ago

Job description

Overview
The Senior Medical 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
Medical Management Strategy and Policy
• 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
Medical Management Programs
• 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
Stakeholder Engagement
• Advises and collaborates with the Chief Medical Officer (CMO) and Medical 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
Leadership
• 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
Other
• May engage in other clinical policies and program work within the MassHealth portfolio
• Other duties as assigned
Qualifications
LICENSURE/CERTIFICATION
• Current, unrestricted physician license in Massachusetts throughout employment with OCA
REQUIRED EDUCATION
• M.D. or D.O. degree required
• Board Certified in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards; Internal Medicine or Family Medicine preferred
REQUIRED QUALIFICATIONS
• At least 5 years experience in direct patient care post-residency
• At least 5 years experience in utilization management in a managed care organization/health plan
• In active clinical practice throughout employment with the Office of Clinical Affairs; internal medicine or family medicine preferred
• Thorough knowledge of the principles and practices of medical management including utilization management
• Excellent oral and written communication and presentation skills
• Must work two days per week on site in Boston and/or Quincy during normal business hours
Additional Information
Preferred Qualifications:
PREFERRED EDUCATION
  • Master of Health Administration (MHA), Master of Public Health (MPH), or Master of Business Administration (MBA) in Healthcare Management preferred

PREFERRED QUALIFICATIONS
  • Demonstrated commitment to serving Medicaid patients
  • Thorough knowledge of Medicaid and related regulations

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