Utilization Management Transplant Coordinator

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 world's 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. The role is an integral part of our clinical coordination team, providing support to providers, facilities, and members to ensure streamlined end-to-end transplant coordination. This position will serve as the single point of contact for facilities and providers for members who require transplant support, including planning, utilization review, authorization, and post‑transplant follow‑up. Candidates must have experience working with provider and/or member‑facing organ transplant teams, with a demonstrated understanding of the clinical drivers of transplant care and managed care objectives that influence access, authorization, and delivery of transplant services. This includes the ability to align clinical needs with payer requirements to ensure timely, appropriate, and compliant services. The role will track all members across lines of business identified for the transplant program and collaborate closely with Utilization Management, Care Management, and Medical Director teams to support transplant‑specific clinical, operational, and care coordination needs. Essential Functions In conjunction with other team members, ensures that transplant coordination is holistic and managed from end to end. Directly interact with providers and their staff to obtain additional clinical information, as well as with members or their advocates to understand the full extent of the need to plan transplant activities. Review information and provide recommendations to the collaborative team based on analysis of the clinical material. Tracks and monitors the status of transplant eligible members to ensure comprehensive support and management. Coordinates communication between patients, healthcare providers, and insurance companies regarding discharge needs. Obtains appropriate authorizations and tracks each member individually to ensure accuracy in the file and to provide the full support required to coordinate transplant activities. Participates in interdisciplinary meetings to discuss complex cases and recommend solutions. Education Associate's Degree Nursing required or Bachelor's Degree Healthcare Administration required or Bachelor's Degree Related Field of Study required Licenses and Credentials Massachusetts Registered Nurse license preferred Experience At least 2-3 years of experience in health plan clinical services/utilization management required At least 2-3 years of clinical experience required At least 2-3 years of transplant management expertise/knowledge required Knowledge, Skills, and Abilities Strong analytical and critical thinking skills. Excellent verbal and written communication abilities. Proficient in using electronic health records (EHR) and billing systems. Detail‑oriented with strong organizational skills. Ability to handle sensitive information with confidentiality and professionalism. Strong interpersonal skills to work effectively with various stakeholders. Working Conditions This is a part‑time 20‑hour/week position. The schedule can be flexible within Monday through Friday business hours. Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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. #J-18808-Ljbffr Mass General Brigham Health Plan