Remote Utilization Management Supervisor – Medicare & DSNP

Partner's Healthcare; Somerville (MA); On-site; USD 99,000 - 145,000; Full time

Job summary

Mass General Brigham Health Plan is seeking a Supervising Utilization Management professional to oversee the daily operations of the DSNP utilization management staff. This remote role requires guiding licensed clinicians, coaching staff, and ensuring timely, high-quality reviews in accordance with policies and regulations.

Ideal candidates will have an RN license, a bachelor's degree, and CCM experience or certification, with strong MS Office and InterQual proficiency.

Qualifications

• Bachelor's Degree required; experience can be considered in lieu of a degree.
• Massachusetts Registered Nurse (RN) license required.
• Certified Case Manager (CCM) preferred

Responsibilities

• Supervise daily operations of utilization management staff.
• Coach and evaluate licensed clinical staff.
• Monitor productivity, ensure timely reviews and quality of work.
• Report staff productivity trends to the manager and adjust as needed.
• Ensure site assignments, reports, and lists are up-to-date.
• Lead monthly reviews of staff roles, metrics, and quality of work.
• Develop tools/workflows to ensure accuracy of reviews and documentation.

Skills

MS Office

InterQual

Verbal communication

Written communication

Interpersonal skills

Education

Bachelor's degree

CCM certification preferred

Tools

Microsoft Office

McKesson InterQual

Job description

Mass General Brigham Health Plan is seeking a Supervising Utilization Management professional to oversee the daily operations of the DSNP utilization management staff. This remote role requires guiding licensed clinicians, coaching staff, and ensuring timely, high-quality reviews in accordance with policies and regulations.

Ideal candidates will have an RN license, a bachelor's degree, and CCM experience or certification, with strong MS Office and InterQual proficiency.