[Hiring] Vendor Authorization Specialist @Mass General Brigham

Role Description

This role will be responsible for supporting vendor-related authorizations and ensuring effective collaboration between the Utilization Management (UM) department and vendors.

• 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.

Qualifications

• Education: 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.

Requirements

• 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.
• Remote Type: Remote
• Work Location: 399 Revolution Drive
• Scheduled Weekly Hours: 40
• Employee Type: Regular
• Work Shift: Day (United States of America)
• Pay Range: $58,656.00 - $142,448.80/Annual
• Grade: 98TEMP

Benefits

• Competitive salaries and a benefits package with flexible work options.
• Career growth opportunities.
• Recognition programs designed to celebrate contributions and support professional growth.