Remote RN: Vendor Authorization & UM Liaison

Partner's Healthcare; Somerville (MA); Remote; USD 90,000 - 107,000; Full time

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking a role to support vendor-related authorizations within Utilization Management. The position collaborates with UM and vendors to ensure accurate criteria application and timely issue resolution.

You will work in a remote capacity with occasional onsite meetings in Somerville, MA, and must meet nursing licensure requirements. The role emphasizes equity, patient care, and streamlined operations within a leading healthcare system.

Qualifications

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

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.

Skills

Utilization review

Interqual

Milliman

Payer setting experience

Acute care experience

Education

Associate’s Degree in Nursing

Bachelor’s Degree in Nursing

Job description

Mass General Brigham Health Plan Holding Company, Inc. is seeking a role to support vendor-related authorizations within Utilization Management. The position collaborates with UM and vendors to ensure accurate criteria application and timely issue resolution.

You will work in a remote capacity with occasional onsite meetings in Somerville, MA, and must meet nursing licensure requirements. The role emphasizes equity, patient care, and streamlined operations within a leading healthcare system.