Site: Mass General Brigham Health Plan Holding Company, Inc.
Job SummaryGiven equity, this position will pay somewhere between $90,000 to $107,000 annually.
This role will be responsible for supporting vendor-related authorizations and ensuring effective collaboration between the Utilization Management (UM) department and vendors.
Key responsibilities will include:
-Processing and managing vendor authorizations.
-Supporting vendor authorization for reporting issues.
-Maintaining authorization code management and ensuring the appropriate application of UM criteria.
-Assisting with the identification, escalation, and resolution of vendor authorization issues.
-Supporting the review and resolution of UM-related letter concerns.
-Collaborating with vendors and UM leadership to address authorization processing issues and promote operational consistency
QualificationsEducation- Associate's Degree Nursing required or Bachelor's Degree Nursing preferred
Licenses and Credentials- Massachusetts Registered Nurse (RN) license required
Experience- At least 2-3 years of utilization review experience is highly preferred
- Experience using Interqual or Milliman is highly preferred
- At least 1-2 years of experience in a payer setting is highly preferred
- At least 1-2 years of experience in an acute care setting is highly preferred
Knowledge, Skills, and Abilities- Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value
- Strong aptitude for technology-based solutions.
- Embrace opportunities to take the complexity out of how we work and what we deliver.
- Listen to our constituents, learn, and act quickly in our ongoing pursuit of meaningful innovation
- Current in healthcare trends.
- Ability to inject energy, when and where it's needed.
- Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
- Be accountable for delivering high-quality work. Act with a clear sense of ownership.
- Bring fresh ideas forward by actively listening to and working with employees and the people we serve.
- Communicate respectfully and professionally with colleagues
- Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
Additional Job Details (if applicable)Working Conditions- Would need to be available for "on call" for a minimum of once per month with the possibility of that increasing depending on staff availability; Approximately 6 months after hire.
- This is a remote role with occasional onsite team meetings in Somerville, MA.
- 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
Given equity, this position will pay somewhere between $90,000 to $107,000 annually.
Remote TypeRemote
Work Location399 Revolution Drive
Scheduled Weekly Hours40
Employee TypeRegular
Work ShiftDay (United States of America)
Pay Range$58,656.00 - $142,448.80/Annual
Grade98TEMP
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.
