Massachusetts Licensed Utilization Manager

Job Summary

Leading a team of registered nurses and clinical support professionals, the full-time Massachusetts Licensed Utilization Manager will oversee utilization management services across Commercial, Medicare, and Medicaid lines of business while driving quality improvement initiatives and ensuring regulatory compliance in a fully remote role.

Key responsibilities:

• Manage, mentor, and develop clinical staff while monitoring team performance and implementing performance improvements
• Oversee utilization management processes and collaborate with the Medical Director to develop quality improvement activities
• Build strategic partnerships with vendors and internal teams, presenting updates and recommendations to executive leadership

Required qualifications:

• Bachelor's Degree in Nursing, required
• Active RN License in Massachusetts, required
• Minimum of 5 years of case management and/or utilization management experience
• Demonstrated leadership and project management experience
• Strong knowledge of regulatory requirements and NCQA accreditation standards