Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Manages a department of utilization review professionals usually consisting of Registered Nurses, Social Workers and other paraprofessional roles. Develops and oversees policies and processes for the team and collaborates with other departments to improve the organization's utilization.
Job Summary
Primary Responsibilities:-Manages team and related staff, including hiring, training, supervision, and performance management.
-Participates in policy and procedure review and development.
-Protects healthcare organization value by keeping information confidential, cautioning others regarding potential breaches.
-Maintains awareness of health insurance changes.
-Maintains compliance with regulation changes affecting utilization management.
Qualifications
What You'll Bring
Qualification Requirements:
Bachelor's Degree Nursing
Registered Nurse (RN) license
3+ years of Utilization Review experience
2+ years management experience
Preferred Skills:
Master’s Degree Nursing
Change management experience
Integration experience
Workday, UKG, Epic, NCG and/or InterQual experience
Medical Necessity Appeals and Denials experience
Peer to Peer experience
Additional Knowledge, Skills and Abilities:
Excellent team communication skills.
Strong interpersonal skills, with the ability to develop, motivate and inspire a team.
Strong team player that is able to multitask with multiple interruptions in a deadline-intense environment.
Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
Understanding the implications of new information for both current and future problem-solving and decision-making.
Additional Job Details (if applicable)
Schedule and Work Model
Remote
Full-time (40 hours) Monday through Friday, standard business hours with minimal weekend coverage
Employees must use a stable, secure, and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment.
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$58,656.00 - $142,448.80/AnnualGrade
98TEMPAt Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
EEO Statement:
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.
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What We Do
Mass General Brigham is an integrated academic health care system, uniting great minds to solve the hardest problems in medicine for our communities and the world. Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services. Mass General Brigham is a nonprofit organization that is committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations and a principal teaching affiliate of Harvard Medical School.
