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Utilization Manager Jobs in Somerville, 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 Somerville, MA

Utilization Manager information

See Somerville, MA salary details

$42.6K

$99.3K

$182.8K

How much do utilization manager jobs pay per year?

As of Sep 3, 2026, the average yearly pay for utilization manager in Somerville, MA is $99,320.00, according to ZipRecruiter salary data. Most workers in this role earn between $64,900.00 and $119,500.00 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.

More about Utilization Manager jobs

What job categories do people searching Utilization Manager jobs in Somerville, MA look for?

The top searched job categories for Utilization Manager jobs in Somerville, MA are:

What cities near Somerville, MA are hiring for Utilization Manager jobs?

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

Utilization Manager jobs near you
Infographic showing various Utilization Manager job openings in Somerville, MA as of August 2026, with employment types broken down into 85% Full Time, 14% Part Time, and 1% Contract. Highlights an 81% Physical, 2% Hybrid, and 17% Remote job distribution, with an average salary of $99,320 per year, or $47.8 per hour.

Pharmacist - Waltham, Massachusetts

RPh on the Go

Waltham, MA • Remote

$55 - $65/hr

Contractor

Medical

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

Job description

A remote Pharmacist opportunity is available with a leading healthcare provider, offering a contract-to-hire position. This role requires a dedicated professional with strong clinical judgment and experience in utilization management, focusing on Part B drug and biologic prior authorization requests and appeals.

Location: Remote (open to licensed pharmacists from any state)
Schedule: Monday–Friday, 12:00 PM–8:30 PM EST
Weekend & Holiday Rotation: Mandatory (no days off except emergencies from 01/01/27 to 03/31/27)
Contract Duration: 10/01/26 to 03/31/27 (6 months)

Key Responsibilities:

  • Review and evaluate Part B drug and biologic prior authorization requests and appeals according to clinical policies and Medicare requirements.
  • Apply utilization management criteria to ensure appropriate authorization decisions.
  • Provide support to internal clinical and non-clinical teams regarding Part B drug policies and workflows.
  • Identify and recommend improvements for review quality, accuracy, and operational efficiency.
  • Adapt to a fast-paced environment with changing workflows, processes, and business needs.
  • Consistently maintain high quality and productivity while managing shifting priorities and workload volumes.

Required Qualifications:

  • PharmD degree and an active pharmacist license in at least one state.
  • Minimum of 2 years of utilization management experience, managed care residency, or applicable specialty pharmacy background.
  • Strong clinical judgment with the ability to independently assess complex Part B drug requests.
  • Familiarity with Part B drug prior authorization and appeals processes.
  • Prior utilization management and prior authorization experience strongly preferred.

This position offers the opportunity to contribute to impactful clinical decisions within a remote setting. If you meet these qualifications and are ready for a challenging role that values clinical expertise, apply today to take the next step in your pharmacy career.

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

Social media

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