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Utilization Manager Jobs in Boston, MA (NOW HIRING)

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 ...

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 ...

RPh on the Go

Pharmacist in Framingham, MA

Framingham, MA · Remote

$55 - $65/hr

Apply clinical policies and utilization management criteria to authorization decisions * Support internal clinical and non-clinical teams with questions related to Part B drug policies and workflows

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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 Sep 2, 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 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 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 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.

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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 85% Full Time, 12% Part Time, and 3% Contract. Highlights an 83% Physical, 2% Hybrid, and 15% Remote job distribution, with an average salary of $98,870 per year, or $47.5 per hour.

Pharmacist | Boston, Massachusetts

RPh on the Go

Boston, MA • Remote

$55 - $65/hr

Contractor

Medical

This job post has expired today. Applications are no longer accepted.

Job description

A remote pharmacist role is available for a temp-to-hire opportunity with a leading healthcare organization focused on Medicare Part B drug management. This position is open to licensed pharmacists nationwide and requires an active pharmacist license in at least one state. The role involves clinical utilization management with an emphasis on reviewing Part B drug and biologic prior authorization requests and appeals.

Key Responsibilities:

  • Review and evaluate Part B drug and biologic prior authorization requests and appeals using clinical policies, utilization management criteria, and Medicare guidelines.
  • Provide support to clinical and non-clinical teams regarding Part B drug policies and workflow processes.
  • Identify opportunities to enhance review quality, accuracy, and operational efficiency.
  • Adapt rapidly to a fast-paced environment with evolving workflows and business requirements.
  • Maintain consistent productivity and quality while balancing changing priorities and work volumes.
  • Participate in a mandatory weekend and holiday rotation with no scheduled days off except emergencies between January 1 and March 31, 2027.

Qualifications:

  • PharmD degree with active pharmacist licensure in at least one U.S. state.
  • Minimum of 2 years’ experience in utilization management, managed care residency, and/or specialty pharmacy.
  • Strong clinical judgment and capacity to independently review complex Part B drug requests.
  • Experience with Part B drug prior authorization and appeals review.
  • Prior exposure to utilization management and prior authorization processes is highly preferred.

Schedule:

  • Monday through Friday, 12:00 PM to 8:30 PM EST
  • Mandatory weekend and holiday rotation during contract period

Location: Remote — open to candidates licensed anywhere in the U.S.

Duration: 6-month contract, from October 1, 2026, through March 31, 2027, with temp-to-hire potential.

This opportunity is ideal for pharmacists seeking an engaging clinical role in utilization management within a dynamic healthcare environment. Apply now to be considered for this remote position and deliver meaningful impact in patient care through expert prior authorization review.

Compensation for this position ranges from $55.00 to $65.00. Eligible candidates may also receive healthcare benefits, housing, and meals/incidentals. Full details of our healthcare benefits plan can be found here. This posting is open for 60 days after the posting date.

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About RPh on the Go

Sourced by ZipRecruiter

At RPh on the Go, we’re all about pharmacists. As a company started by pharmacists for pharmacists, we understand the extraordinary responsibilities you take on every day, the tremendous demands placed on you and your colleagues, and the rewards that come with working in one of the country’s most highly respected professions.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Chicago, IL, US

Year founded

1980

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