Remote RN Utilization Management Lead — Quality & Cost

8510 Health New England, Inc.; United States; Remote; USD 108,000 - 147,000; Full time

Job summary

Baystate Health’s Health New England is seeking a Manager of Utilization Management to lead the Utilization Management Health Services Team, driving high-quality, cost-effective care for Commercial, Medicare, and Medicaid. This remote role requires residence in MA or CT, with work hours 8‑4:30 or 9‑5:30, weekdays, no weekends.

Responsibilities include leading a clinical team, monitoring performance, ensuring regulatory compliance, and partnering with leadership to improve member outcomes through

Qualifications

• Bachelor's degree in nursing is required.
• Active RN license in Massachusetts or eligibility to practice.
• Minimum 5 years of progressively responsible case management and/or utilization management.
• Strong leadership, negotiation and project management abilities.
• Knowledge of NCQA, regulatory requirements and healthcare accreditation.

Responsibilities

• Lead and mentor a clinical team of RNs and support staff.
• Oversee utilization management across Commercial, Medicare, and Medicaid.
• Develop quality improvement activities with the Medical Director.
• Monitor performance, provide coaching, and drive process improvements.

Skills

RN License MA

Leadership

Case management

Utilization management

Data analysis

Regulatory compliance

Education

Bachelor's Degree in Nursing

Tools

Microsoft Office

Job description

Baystate Health’s Health New England is seeking a Manager of Utilization Management to lead the Utilization Management Health Services Team, driving high-quality, cost-effective care for Commercial, Medicare, and Medicaid. This remote role requires residence in MA or CT, with work hours 8‑4:30 or 9‑5:30, weekdays, no weekends.

Responsibilities include leading a clinical team, monitoring performance, ensuring regulatory compliance, and partnering with leadership to improve member outcomes through