Remote Vendor Authorization RN | UM & Payer Collaboration

Mass General Brigham Health Plan Holding Company, Inc.; Somerville (MA); Remote; USD 90,000 - 107,000; Full time

Benefits offered by this job

Flexible work options

Career growth opportunities

Job summary

Mass General Brigham Health Plan is seeking an experienced RN for utilization management with a focus on processing and managing UM authorizations. The role supports collaboration between the UM department and external vendors to ensure efficient authorization processing and adherence to criteria.

The ideal candidate will have 2–3 years of utilization review experience, experience with InterQual or Milliman, and an active Massachusetts RN license.

Qualifications

• Associate's Degree Nursing required or Bachelor's Degree Nursing preferred.
• Active Massachusetts RN license required.
• Experience in utilization review and payer settings is highly preferred.

Responsibilities

• Process and manage utilization management authorizations.
• Collaborate with UM leadership and vendors to address authorization processing issues.
• Ensure appropriate application of InterQual/Milliman criteria.
• Manage and resolve vendor authorization issues and UM-related correspondence.
• Be available on-call as required and participate in on-site meetings in Somerville, MA when needed.

Skills

Utilization Review

Nursing (RN)

InterQual/Milliman

Payer Experience

Remote Collaboration

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Job description

Mass General Brigham Health Plan is seeking an experienced RN for utilization management with a focus on processing and managing UM authorizations. The role supports collaboration between the UM department and external vendors to ensure efficient authorization processing and adherence to criteria.

The ideal candidate will have 2–3 years of utilization review experience, experience with InterQual or Milliman, and an active Massachusetts RN license.