Manager Utilization Review
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. The Opportunity Compensation offered for this position is up to $200k+ dependent on level of experience. 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.
Requirements
- Bachelor's Degree Nursing
- Registered Nurse (RN) license
- 3+ years of Utilization Review experience
- 2+ years management experience
Nice To Haves
- 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
- 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.
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.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Number of Employees
5,001-10,000 employees
