Remote RN: Vendor Authorization Specialist

Mass General Brigham Health Plan; Somerville (MA); Remote; USD 90,000 - 107,000; Full time

Job summary

Mass General Brigham Health Plan is seeking a skilled RN to support vendor-related authorizations and ensure effective collaboration between the Utilization Management (UM) department and vendors. The position requires on-call availability monthly and a remote work setup with occasional onsite meetings in Somerville, MA.

The role operates Monday through Friday during Eastern business hours, with a 40-hour work week.

Qualifications

• Associate's Degree Nursing required or Bachelor's Degree Nursing preferred.
• Massachusetts RN license required.
• 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.

Responsibilities

• 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

Education

Associate's Degree Nursing

Bachelor's Degree Nursing preferred

Massachusetts RN license

Job description

Mass General Brigham Health Plan is seeking a skilled RN to support vendor-related authorizations and ensure effective collaboration between the Utilization Management (UM) department and vendors. The position requires on-call availability monthly and a remote work setup with occasional onsite meetings in Somerville, MA.

The role operates Monday through Friday during Eastern business hours, with a 40-hour work week.