RN Utilization Management Supervisor – Medicare & Duals (Remote)

Mass General Brigham Health Plan Holding Company, Inc.; Somerville (MA); On-site; USD 99,000 - 145,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonuses and differentials

Job summary

Mass General Brigham Health Plan is seeking a supervisor to oversee the daily operations of the DSNP utilization management staff, providing coaching, supervision, and evaluation of licensed clinical team members. The role collaborates with the Manager, Clinical to support new products and address business needs.

This remote position can be performed from most US states, with a Monday–Friday daytime schedule.

Qualifications

• Massachusetts RN license required.
• CCM certification preferred.
• 3–5 years of managed care utilization management experience.
• Experience with inpatient and outpatient reviews (D-SNP).
• Understanding of MA LTSS is highly preferred.

Responsibilities

• Expertise in clinical inpatient and outpatient utilization management reviews using InterQual.
• Educate staff on quality review requirements and documentation guidelines.
• Monitor staff productivity and adjust assignments to meet productivity goals.
• Report staff productivity trends to the manager and escalate concerns.
• Ensure site assignments, hospital reports, and related docs are updated.
• Monthly review of staff roles, metrics and quality of work for MA regulations and Mass General Brigham Health Plan goals.
• Develop tools and workflows to ensure accuracy and completeness of reviews and documentation.

Skills

Microsoft Office

InterQual

Verbal communication

Written communication

Interpersonal skills

Education

Bachelor's Degree

Job description

Mass General Brigham Health Plan is seeking a supervisor to oversee the daily operations of the DSNP utilization management staff, providing coaching, supervision, and evaluation of licensed clinical team members. The role collaborates with the Manager, Clinical to support new products and address business needs.

This remote position can be performed from most US states, with a Monday–Friday daytime schedule.