Supervisor, Utilization Management

Mass General Brigham • Somerville, MA

2d • 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. The supervisor will work closely with the Manager, Clinical, to oversee the daily operations of the utilization management staff. The supervisor will be responsible for the direct coaching, supervision, and evaluation of licensed clinical staff. The supervisor may be required to participate in projects across the organization to support new products or address business needs

Requirements

• Bachelor's Degree required or the equivalent combination of training and experience
• MA Registered Nurse (RN) license required
• At least 3-5 years of relevant experience in managed care setting, knowledge of utilization management required
• Expertise in clinical inpatient and outpatient care required
• Proficient user with Microsoft Office and McKesson InterQual.
• Excellent verbal, written, listening, and interpersonal skills.
• Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value.

Nice To Haves

• Certified Case Manager [CCM] preferred
• Leadership and/or supervisory experience preferred

Responsibilities

• Expertise in clinical inpatient and outpatient utilization management reviews utilizing InterQual®, company policies and procedures, and other resources as determined by review, including physician reviews as needed.
• Educate staff on quality review requirements and documentation guidelines, with emphasis on highly accurate and specific documentation consistent with national regulations and practice.
• Monitor individual productivity and adjust assignments as needed to support productivity goals, ensure quality reviews, maintain timeliness, and achieve an equitable distribution of cases.
• Report staff productivity trends and any other department/staff concerns to the manager as needed.
• Ensure site assignments, phone/fax lists, hospital reports, etc., are updated and accurate.
• Monthly review of staff roles, metrics, and quality of work, making readjustments to align with MA regulations and Mass General Brigham Health Plan goals as needed.
• Develop tools and workflows to ensure accuracy and completeness of reviews and documentation.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager