Remote RN Vendor Authorization Specialist

Mass General Brigham; United States; Remote; USD 90,000 - 107,000; Full time

Benefits offered by this job

Flexible work options

Career growth opportunities

Competitive benefits package

Job summary

Mass General Brigham Health Plan is seeking a Remote Utilization Management Professional to support vendor-related authorizations and ensure effective collaboration between the UM department and vendors.

The role may require occasional onsite meetings in Somerville, MA, and requires availability for on-call duties at least monthly. Ideal candidates have 2–3 years in utilization review, experience with InterQual/Milliman, and payer/acute care experience.

Qualifications

• Associate’s Degree in Nursing required or Bachelor’s Degree in Nursing preferred.
• Massachusetts RN license is required.
• 2–3 years of utilization review experience is highly preferred.
• Experience with InterQual or Milliman is highly preferred.
• 1–2 years of payer experience is highly preferred.
• 1–2 years of acute care experience is highly preferred.
• Demonstrates Mass General Brigham Health Plan’s core principles and commitment to service.

Responsibilities

• Process and manage vendor authorizations.
• Support vendor authorization for reporting issues.
• Maintain authorization code management and ensure UM criteria are applied.
• Assist with escalation and resolution of vendor authorization issues.
• Support review and resolution of UM-related letter concerns.
• Collaborate with vendors and UM leadership to address processing issues and ensure consistency.

Skills

Utilization review

InterQual/Milliman

Payer systems knowledge

HIPAA & data privacy

Strong communication

Education

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

Massachusetts RN license

Job description

Mass General Brigham Health Plan is seeking a Remote Utilization Management Professional to support vendor-related authorizations and ensure effective collaboration between the UM department and vendors.

The role may require occasional onsite meetings in Somerville, MA, and requires availability for on-call duties at least monthly. Ideal candidates have 2–3 years in utilization review, experience with InterQual/Milliman, and payer/acute care experience.