Remote Utilization Management Supervisor – Medicare & Duals

Mass General Brigham Incorporated; Somerville, Northern (MA, KY); Hybrid; USD 99,000 - 145,000; Full time

Benefits offered by this job

Flexible work options

Job summary

Mass General Brigham Health Plan Holding Company, Inc. seeks a Supervisor, Clinical to oversee the DSNP utilization management team and coach licensed staff. The role emphasizes quality reviews, adherence to regulations, and project participation to meet business needs.

The remote position requires MA RN licensure, 3–5 years in managed care, CCM preferred, and strong documentation and leadership skills to ensure accurate, timely reviews across inpatient and outpatient settings.

Qualifications

• Bachelor's degree required.
• Massachusetts RN license required.
• CCM certification preferred.
• 3–5 years in a managed care setting with utilization management experience.

Responsibilities

• Oversee daily operations of the DSNP utilization management staff.
• Coach, supervise, and evaluate licensed clinical staff.
• Participate in cross-organizational projects to support new products or business needs.
• Ensure productivity, timeliness, and quality reviews; adjust assignments as needed.
• Maintain updated site assignments, reports, and documentation.

Skills

Leadership

Supervisory experience

Communication

Clinical knowledge

Education

Bachelor's degree

Massachusetts RN license

CCM certification preferred

Tools

McKesson InterQual

Microsoft Office

Job description

Mass General Brigham Health Plan Holding Company, Inc. seeks a Supervisor, Clinical to oversee the DSNP utilization management team and coach licensed staff. The role emphasizes quality reviews, adherence to regulations, and project participation to meet business needs.

The remote position requires MA RN licensure, 3–5 years in managed care, CCM preferred, and strong documentation and leadership skills to ensure accurate, timely reviews across inpatient and outpatient settings.