Vendor Authorization Specialist, Registered Nurse

Mass General Brigham Health Plan Position

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.

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:

• 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):

• 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

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