Vendor Authorization Specialist, Registered Nurse

Site: Mass General Brigham Health Plan Holding Company Inc.

Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

Given equity this position will pay somewhere between $90000 to $107000 annually.

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 worlds 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.

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

Qualifications

Education

• Associates Degree Nursing required or Bachelors 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 Plans 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 its 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 $90000 to $107000 annually.

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$58656.00 - $142448.80/Annual

Grade

98TEMP

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 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.

EEO Statement:

8925 Mass General Brigham Health Plan Holding Company Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .

Mass General Brigham Competency Framework

At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.

Required Experience:

IC