DSNP Utilization Management Nurse

Mass General Brigham • Somerville, MA

8d • Remote

About The Position

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. Job Summary The D-SNP UM Case Manager, RN performs utilization management activities primarily for D-SNP (OneCare and Senior Care Options), including review of integrated organization determinations for outpatient, inpatient, post-acute, and long-term services and supports (LTSS) following CMS and EOHHS regulations.

Requirements

• Associate's Degree Nursing required; Bachelor's Degree Nursing preferred
• Massachusetts Registered Nurse license required
• Basic Life Support [BLS Certification] Certification preferred
• At least 2-3 years of utilization management strongly preferred
• Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
• Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
• Ability to establish strong rapport and relationships with patients and staff.
• Proficient in Microsoft Office and industry related software programs.
• Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
• Ability to maintain client and staff confidentiality.
• Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care.
• Knowledge of Healthcare and Managed Care preferred.

Nice To Haves

• Experience applying National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and LTSS guidelines highly preferred
• InterQual experience preferred

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees