Massachusetts Licensed Utilization Manager

Job Summary

Overseeing all utilization management activities, the full-time Massachusetts Licensed Utilization Manager will ensure consistency of services and achievement of utilization targets while working remotely.

Key responsibilities:

• Assist in the coordination and management of the pre-determination process for medical and dental services
• Interact with providers and staff to manage benefits in alignment with state regulations and organizational policies
• Analyze utilization data to formulate recommendations that enhance member quality of care and outcomes

Required qualifications:

• Current, unrestricted RN licensure in Massachusetts
• Associate's Degree in Nursing required; BSN preferred
• Minimum of five years of clinical experience
• Five years of experience in case management, utilization management, or quality improvement
• Preferred two years of utilization management experience and managed care experience