Remote RN Utilization Management Leader

Ali Aydi; Springfield (MA); 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 our Utilization Management Health Services Team in Springfield, MA.

The Manager oversees a team of registered nurses and clinical staff, drives quality improvement, ensures regulatory compliance, and partners with the Medical Director to shape cost-effective, member-centered care across Commercial, Medicare, and Medicaid lines. This fully remote role requires residency in MA or CT.

Qualifications

• Bachelor's Degree in Nursing is required.
• Active RN License in Massachusetts is required.
• Minimum of 5 years in case management and/or utilization management.
• Demonstrated leadership and negotiation experience.
• Knowledge of NCQA accreditation standards.
• Familiarity with data collection, analysis, and presentation.

Responsibilities

• Lead a clinical team of RNs and support staff.
• Oversee utilization management across Commercial, Medicare, and Medicaid.
• Develop and implement quality improvement initiatives.
• Present updates to executive leadership and peers.
• Collaborate with internal teams to support projects.

Skills

Nursing leadership

Regulatory knowledge

Data analysis

Communication

Project management

MS Office

Education

Bachelor's Degree in Nursing

Tools

MS Office

Job description

Baystate Health’s Health New England is seeking a Manager of Utilization Management to lead our Utilization Management Health Services Team in Springfield, MA.

The Manager oversees a team of registered nurses and clinical staff, drives quality improvement, ensures regulatory compliance, and partners with the Medical Director to shape cost-effective, member-centered care across Commercial, Medicare, and Medicaid lines. This fully remote role requires residency in MA or CT.