Utilization Management Nurse Manager - Remote

Baystate Health; 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 our Utilization Management Health Services Team and shape the delivery of high-quality, cost-effective, member-centered care in Springfield, MA.

The Manager will oversee utilization management processes across Commercial, Medicare, and Medicaid lines, lead a team of registered nurses and support staff, and partner with the Medical Director to drive quality improvement and ensure regulatory compliance.

Qualifications

• Bachelor's degree in Nursing required.
• Active RN license in Massachusetts required.
• Minimum of 5 years of progressively responsible case management and/or utilization management experience.
• Demonstrated leadership and negotiation experience.

Responsibilities

• Lead and mentor a clinical team of RNs and support staff.
• Monitor performance, provide coaching and education.
• Oversee utilization management across Commercial, Medicare, and Medicaid.
• Develop quality improvement activities with Medical Director.
• Use data to measure outcomes and drive improvements.
• Ensure regulatory compliance (NCQA, other standards).

Skills

Leadership

Negotiation

Project management

Data analysis

Communication

Education

Bachelor's Degree in Nursing

Tools

Microsoft Office

Excel

Access

Word

PowerPoint

Job description

Baystate Health's Health New England is seeking a Manager of Utilization Management to lead our Utilization Management Health Services Team and shape the delivery of high-quality, cost-effective, member-centered care in Springfield, MA.

The Manager will oversee utilization management processes across Commercial, Medicare, and Medicaid lines, lead a team of registered nurses and support staff, and partner with the Medical Director to drive quality improvement and ensure regulatory compliance.