Remote Utilization Management Supervisor – Medicare/DSNP

your Jared; Somerville, Northern (MA, KY); Hybrid; USD 99,000 - 145,000; Full time

Job summary

Mass General Brigham Health Plan Holding Company, Inc. is seeking a supervisor to oversee DSNP utilization management staff, including coaching and evaluating licensed clinicians. The role focuses on adherence to national and MA regulations and quality reviews.

Qualified candidates will have 3–5 years in managed care, an RN license, and familiarity with InterQual tools. This remote position may involve occasional weekend work and requires a HIPAA-compliant workspace.

Qualifications

• Bachelor's degree required; experience can be considered in lieu of a degree.
• Massachusetts RN license required; CCM preferred.
• 3–5 years of experience in a managed care setting with utilization management knowledge.

Responsibilities

• Oversee daily operations of DSNP utilization management staff.
• Coach, supervise, and evaluate licensed clinical staff.
• Ensure accuracy, timeliness, and consistency with MA regulations and Mass General Brigham Health Plan goals.
• Develop tools/workflows to improve reviews and documentation.
• Monitor staff productivity and adjust assignments as needed.
• Report productivity trends to the manager.

Skills

Leadership

Communication

Quality documentation

Utilization management knowledge

Education

Bachelor's Degree

RN license (Massachusetts)

Tools

InterQual

McKesson InterQual

Microsoft Office

Job description

Mass General Brigham Health Plan Holding Company, Inc. is seeking a supervisor to oversee DSNP utilization management staff, including coaching and evaluating licensed clinicians. The role focuses on adherence to national and MA regulations and quality reviews.

Qualified candidates will have 3–5 years in managed care, an RN license, and familiarity with InterQual tools. This remote position may involve occasional weekend work and requires a HIPAA-compliant workspace.