Site: Mass General Brigham Health Plan Holding Company, Inc.
Job SummaryMass 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.
Conducts and leads research related to medical technologies, products, and services. Support decisions on coverage, utilization management tools, including prior authorization, and medical policy development. Manages the Medical Technology Assessment Committee and the Prior Authorization Committee in collaboration with committee chairs. Partners closely with medical leadership and cross-functional stakeholders to identify policy needs, to make strategic decisions on coverage and utilization management policies, to support configuration, and to ensure alignment with clinical best practices and applicable legal and regulatory requirements.
Essential Functions
-Prepare the agenda for the Medical Technology Assessment Committee (in collaboration with the Medical Directors and the Manager, Research and Policy Development).
-Research and summarize medical literature, benchmarking, coding, regulations, and medical economics analysis for new medical technologies and for products/services designated as Experimental/Investigational.
-Update and maintain the list of services designated as Experimental/Investigational for each line of business.
-Make recommendations on coverage status based on the synthesis of the research.
-Prepare agenda for the Prior Authorization Committee (in collaboration with the chair, co-chair, and analytics team).
-Research relevant coding, benchmarking, and regulations for the Prior Authorization Committee and the Medical Policy Committee.
-Make recommendations to the Prior Authorization Committee on utilization management strategies, informed by value factor analysis and other relevant considerations.
QualificationsEducation- Bachelor's Degree required and Master's Degree preferred; experience can be considered in lieu of a degree
Experience- At least 3-5 years of research experience related to medical technology and/or healthcare services required
- At least 2-3 years of health plan, managed care, or health insurance industry experience preferred
- At least 1-2 years of experience with medical policy development, utilization management, or health technology assessment preferred
Knowledge, Skills, and Abilities- Strong, demonstrated track record of ability to execute on time, on budget, and on scope.
- Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
- Strong research and analytical skills.
- Ability to work collaboratively with cross-functional teams.
- Working knowledge of medical coding systems (CPT, HCPCS, ICD-10) and reimbursement methodologies.
- Familiarity with applicable regulatory and accreditation requirements (e.g., CMS, state insurance regulations, NCQA).
- Strong verbal and written communication skills, including the ability to prepare clear committee materials and present findings to medical leadership.
- Proficiency with Microsoft Office (Word, Excel, PowerPoint) and comfort learning claims/coverage policy systems.
Additional Job Details (if applicable)Working Conditions - This is a remote role that can be done from most US states
- Monday through Friday, eastern business hours required
- Remote workdays require a stable, secure, quiet, and HIPAA-compliant workspace. This will be confirmed via Microsoft Teams video for all employees
Remote TypeRemote
Work Location399 Revolution Drive
Scheduled Weekly Hours40
Employee TypeRegular
Work ShiftDay (United States of America)
Pay Range$79,560.00 - $115,720.80/Annual
Grade7
At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
