Massachusetts Licensed Utilization Manager

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