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Utilization Manager Jobs in Hopkinton, MA (NOW HIRING)

Elevance Health

Wound Care Utilization Management RN

Woburn, MA

$39.34 - $56.20/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Wound Care Utilization Management RN Virtual : This role enables associates to workvirtually ... Unless specified as primarily virtual by the hiring manager, associates are required to work at an ...

STI

Case Manager - Registered Nurse

Cambridge, MA · On-site

Case Manager - Registered Nurse Cambridge, MA/Local candidates not accepted*** 3-6 Months ... Primary Responsibilities : 1. Performs utilization review and discharge planning to inpatient ...

STI

Case Manager - Registered Nurse

Cambridge, MA · On-site

Case Manager - Registered Nurse Cambridge, MA/Local candidates not accepted*** 3-6 Months ... Primary Responsibilities : 1. Performs utilization review and discharge planning to inpatient ...

Superbeo

RN-Case Manager

Cambridge, MA · On-site

Primary Responsibilities: 1. Performs utilization review and discharge planning to inpatient ... Abides by MACIPA Case Management standards as per the MACIPA CM guidelines. Required Qualifications ...

Briljent

Clinical Domain Project Manager (PBM)

Boston, MA · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Assigned projects span drug coverage administration, Preferred Drug List (PDL) management, prior authorization, utilization management, drug utilization review, clinical criteria configuration, and ...

Briljent

Clinical Domain Project Manager (PBM)

Boston, MA · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Assigned projects span drug coverage administration, Preferred Drug List (PDL) management, prior authorization, utilization management, drug utilization review, clinical criteria configuration, and ...

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Showing results 21-40

All JobsUtilization JobsUtilization Manager JobsUtilization Manager Jobs in Hopkinton, MA

Utilization Manager information

See Hopkinton, MA salary details

$42.9K

$100K

$184K

How much do utilization manager jobs pay per year?

As of Aug 14, 2026, the average yearly pay for utilization manager in Hopkinton, MA is $99,997.00, according to ZipRecruiter salary data. Most workers in this role earn between $65,400.00 and $120,300.00 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 cities near Hopkinton, MA are hiring for Utilization Manager jobs?

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

Utilization Manager jobs near you

Concurrent Review RN

Healthcare Support Staffing

Waltham, MA

Full-time

Re-posted 5 days ago

Job description

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

Job Description

Day to Day Duties:


  • This person will be reviewing charts to ensure members are receiving the most appropriate/cost effective care. They will be reviewing the progress of discharge planning to make sure they take appropriate action to keep members out of the hospital. This will be 100% onsite (no travel).
  • Company Job Description:Position Purpose: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to emergent/urgent and continued stay reviews.
  • Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
  • Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
  • Collaborate with various staff within provider networks and discharge planning team electronically, telephonically, or onsite to coordinate member care
  • Conduct discharge planning
  • Educate providers on utilization and medical management processes
  • Provide clinical knowledge and act as a clinical resource to non-clinical team staff
  • Enter and maintain pertinent clinical information in various medical management systems
  • Direct care to participating network providers
  • Participate in utilization management committees and work on special projects related to utilization management as needed
  • Serve as a subject matter expert for questions or issues for other Concurrent Review Nurses and Prior Authorization Nurses
  • Audit case reviews to ensure compliance with utilization management policies and procedures
  • Assist with the development of utilization management workflows, policies, and procedures
Qualifications

Minimum Education/Licensures/Qualifications:

  • RN licensure
  • associates degree in nursing
  • 3+ years of UM experience in a managed care setting (this is a must)
  • 2+ years of clinical nursing experience

 Shift:

  • 8:00-5:00 100% office Based 


Additional Information

Interested in being considered?

If you are interested in being considered for this position, please click the apply button below.  Or call Ashley Greene 407-478-0332 ext 169

Healthcare Support logo

About Healthcare Support

Sourced by ZipRecruiter

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!Healthcare Support Staffing, Inc. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.

Industry

Recruiting and staffing services

Company size

201 - 500 Employees

Headquarters location

Maitland, FL, US

Year founded

2003

Social media

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