Remote Utilization Management Supervisor – Medicare & Duals

Mass General Brigham Health Plan; Somerville (MA); Remote; USD 99,000 - 145,000; Full time

Job summary

Mass General Brigham Health Plan is seeking a supervisor to manage DSNP utilization management staff, ensuring quality reviews and regulatory compliance. You will coach licensed clinicians, monitor productivity, and coordinate cross-functional projects as needed.

Remote role with daytime schedule, mostly Monday–Friday; MA regulations govern operations. Requires MA RN license, CCM preferred, and 3–5 years in managed care with inpatient/outpatient review experience.

Qualifications

• Bachelor's degree required; experience can substitute for degree.
• RN licensure in MA required; CCM preferred.
• 3–5 years in managed care with inpatient/outpatient review knowledge.

Responsibilities

• Oversee daily operations of DSNP utilization management staff.
• Coach, supervise, and evaluate licensed clinical staff.
• Ensure productivity, quality reviews, timeliness, and equitable case distribution.
• Develop tools/workflows to improve accuracy and documentation.
• Monitor staff metrics and report to manager; align with MA regulations.

Skills

Microsoft Office

McKesson InterQual

Verbal and written communication

Education

Bachelor's Degree

Tools

InterQual software

Job description

Mass General Brigham Health Plan is seeking a supervisor to manage DSNP utilization management staff, ensuring quality reviews and regulatory compliance. You will coach licensed clinicians, monitor productivity, and coordinate cross-functional projects as needed.

Remote role with daytime schedule, mostly Monday–Friday; MA regulations govern operations. Requires MA RN license, CCM preferred, and 3–5 years in managed care with inpatient/outpatient review experience.