[Hiring] Medicare Utilization Management Supervisor @Mass General Brigham

Role Description

The supervisor will work closely with the Manager of Clinical, to oversee the daily operations of roughly 5 Medicare Advantage 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.

Essential Functions

• 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 MedAdv regulations and Mass General Brigham Health Plan goals as needed.
• Develop tools and workflows to ensure accuracy and completeness of reviews and documentation.

Qualifications

• Bachelor's Degree Related Field of Study required (experience can be considered in lieu of a degree)
• Massachusetts Registered Nurse (RN) license
• Certified Case Manager [CCM] preferred
• At least 3-5 years of relevant experience in managed care setting with knowledge of utilization management required
• Expertise in clinical inpatient and outpatient care required
• Leadership and/or supervisory experience preferred
• Proficient user with Microsoft Office and McKesson InterQual
• Excellent verbal, written, listening, and interpersonal skills
• Demonstrate Mass General Brigham Health Plans' core brand principles of always listening, challenging conventions, and providing value

Requirements

• Remote Type: Remote
• Work Location: 399 Revolution Drive
• Scheduled Weekly Hours: 40
• Employee Type: Regular
• Work Shift: Day (United States of America)
• Pay Range: $99,465.60 - $141,804.00/Annual
• Grade: 8

Benefits

• Competitive salaries
• Flexible work options
• Career growth opportunities
• Comprehensive benefits
• Differentials, premiums, and bonuses as applicable
• Recognition programs designed to celebrate contributions and support professional growth