Baystate HealthHiring

Manager of Utilization Management

  • Remote, United States
  • Full-time
  • Lead
  • Posted 5 days ago
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In one line

Manager of Utilization Management is a lead full-time remote role in the United States at a health insurance plan.

About the role

The team reviews care against clinical criteria and keeps costs and quality in balance. The manager works with the medical director on quality initiatives, vendor oversight and regulatory compliance.

At a glance

Pay
Not stated in the posting
Remote scope
Remote, United States
Seniority
Lead
Employment
Full-time
Skills
Utilization management, Case management, NCQA, Medicare, Medicaid
Posted
30 Oct 2026
Last checked
3 Nov 2026

What you will do

  • Manage, mentor and develop registered nurses and clinical support staff
  • Oversee utilization management for commercial, Medicare and Medicaid lines
  • Work with the medical director on quality improvement activities and delegation agreements
  • Use data to track outcomes, spot trends and recommend fixes
  • Monitor compliance with NCQA, MCRA and other regulations
  • Act as relationship manager for assigned vendors

What they look for

  • Bachelor's degree in nursing
  • Active Massachusetts RN license
  • At least five years of case management or utilization management experience, with growing responsibility
  • Leadership and negotiation experience
  • Project management experience
  • Knowledge of NCQA accreditation standards and Medicare and Medicaid rules

A typical week

  • Monday to Friday, 8 to 4:30 or 9 to 5:30
  • No weekends and no holidays
  • Occasional evening meetings

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Questions about this job

Is this job fully remote, and from where?

Yes. The posting lists Manager of Utilization Management as a remote role for candidates in the United States.

What does this job pay?

The posting does not state a salary, so there is no figure to quote.

What experience is needed?

It is a lead role. The posting asks for: bachelor's degree in nursing; active Massachusetts RN license; at least five years of case management or utilization management experience, with growing responsibility. Skills it names include Utilization management, Case management, NCQA, Medicare.

How do I apply with Keywordise AI?

Select Apply with Keywordise AI, sign up and upload your CV. Keywordise writes a CV and a cover letter for this job from your real experience and applies for you. The 7-day free trial needs no card.

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