Utilization Management Transitions of Care Coordinator

Mass General Brigham • Somerville, MA

22h • 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. Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. The Utilization Management Transitions of Care Coordinator role is an integral part of our clinical coordination team by providing support to providers, facilities, and members to ensure a streamlined transition process from one level of care to another. This position will be the single point of contact for facilities and providers when a member requires special support, when a difficult transition plan is in place, or when barriers to obtaining the next level of care arise. This role will track any long-stay members to assist in moving them to the next appropriate level of care. The position collaborates with members of the Utilization Management, Appeal and Grievance, Care Management, and medical director teams to resolve transitional needs.

Requirements

• Associate's Degree Nursing required or Bachelor's Degree Healthcare Administration required or Bachelor's Degree Related Field of Study required
• At least 2-3 years of experience in health plan clinical services/utilization management required
• At least 2-3 years of clinical experience required
• Strong analytical and critical thinking skills.
• Excellent verbal and written communication abilities.
• Proficient in using electronic health records (EHR) and billing systems.
• Detail-oriented with strong organizational skills.
• Ability to handle sensitive information with confidentiality and professionalism.
• Strong interpersonal skills to work effectively with various stakeholders.

Nice To Haves

• Massachusetts Registered Nurse [RN] license preferred

Responsibilities

• In conjunction with other team members, ensures that transitional needs and barriers are resolved in a timely manner to meet regulatory timeframes.
• Directly interact with providers and their staff to obtain additional clinical information, as well as with members or their advocates to understand the full need to transition a member from one level of care to another.
• Review information and provide recommendations to the collaborative team based on analysis of the clinical material.
• Tracks and monitors the status of long-stay inpatient/post-acute cases, ensuring timely discharge planning.
• Identifies trends and patterns in discharge barriers with facilities and providers.
• Coordinates communication between patients, healthcare providers, and insurance companies regarding discharge needs.
• Coordinates communication with state and federal partners to ensure length of stay reporting is timely and accurate, and delivers follow-up information, as requested, by line of business or regulatory partners.
• Participates in interdisciplinary meetings to discuss complex cases and recommend solutions.

Benefits

• competitive salaries
• benefits package with flexible work options
• career growth opportunities
• comprehensive benefits
• differentials
• premiums
• bonuses as applicable
• recognition programs designed to celebrate your contributions and support your professional growth

What This Job Offers

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