Utilization Management Transplant Coordinator

Mass General Brigham•Somerville, MA

1d•Remote

About The Position

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. We are pleased to offer competitive salaries and a benefits package with flexible work options, career growth opportunities, and much more. The role is an integral part of our clinical coordination team, providing support to providers, facilities, and members to ensure streamlined end-to-end transplant coordination. This position will be the single point of contact for facilities and providers for members who require transplant support, planning, utilization review, and follow-up. This role will track all members across lines of business identified for the transplant program. The position collaborates with members of the Utilization Management, Care Management, and medical director teams to support transplant-specific 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
At least 2-3 years of transplant management expertise/knowledge 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 license preferred

Responsibilities

Ensures that transplant coordination is holistic and managed from end to end.
Directly interact with providers and their staff to obtain additional clinical information, as well as with members or their advocates to understand the full extent of the need to plan transplant activities.
Review information and provide recommendations to the collaborative team based on analysis of the clinical material.
Tracks and monitors the status of transplant eligible members to ensure comprehensive support and management.
Coordinates communication between patients, healthcare providers, and insurance companies regarding discharge needs.
Obtains appropriate authorizations and tracks each member individually to ensure accuracy in the file and to provide the full support required to coordinate transplant activities.
Participates in interdisciplinary meetings to discuss complex cases and recommend solutions.