RN Care Management(Remote)

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.

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.

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.

Given equity, this position will pay somewhere between $90,000 to $107,000 annually. 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 UMCM will utilize clinical knowledge to analyze, assess, and render approval decisions, to determine the need for physician review as well as complete determinations following physician review. The ideal candidate will have prior authorization (outpatient review) experience in a managed care setting with commercial health plan knowledge.

Expertise in clinical review for prospective, concurrent, retrospective utilization management reviews utilizing Interqual ®, company policies and procedures, and other resources as determined by review, including physician reviews as needed for all lines of business as per departmental needs

Review authorization requests for medical services, including making initial eligibility and coverage determinations, screening for medical necessity appropriateness, determining if additional information is required, and referral to correct programs within Mass General Brigham Health Plan as needed.

Manage incoming requests for procedures and services including patient medical records and related clinical information.

Strong working knowledge of commercial, self-insured, fully insured and limited network plans.

Adherence to program, departmental and organizational performance metrics including productivity.

Excellent problem solving and customer service skills.

Develop and maintain effective working relationships with internal and external customers

Sound decision-making and time management skills.

Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.

Proficient with Microsoft Word, Excel, Outlook, McKesson InterQual ®, Outlook, SharePoint, PC based operating system, and web-based phone system.

Associate’s Degree Nursing required or Bachelor’s Degree Nursing preferred

Massachusetts Registered Nurse (RN) license required

At least 1-2 years of experience in an acute care setting is highly preferred

Demonstrate Mass General Brigham Health Plan’s core brand principles of always listening, challenging conventions, and providing value

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.

Be accountable for delivering high-quality work. Bring fresh ideas forward by actively listening to and working with employees and the people we serve.

Associate’s Degree Nursing required or Bachelor’s Degree Nursing preferred

Massachusetts Registered Nurse (RN) license required

At least 1-2 years of experience in an acute care setting is highly preferred

Demonstrate Mass General Brigham Health Plan’s core brand principles of always listening, challenging conventions, and providing value

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.

Be accountable for delivering high-quality work. Bring fresh ideas forward by actively listening to and working with employees and the people we serve.

This is a remote role with occasional onsite team meetings in Somerville, MA.

Remote Type

Remote

Work Shift

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. In 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.

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 Veteran’s 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 View phone number on click.appcast.io.

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.

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