RN Vendor Authorization Specialist - UM & Vendors

IntelliResume; Massachusetts; On-site; USD 90,000 - 107,000; Full time

Job summary

Mass General Brigham is seeking a Vendor Authorization Specialist, Registered Nurse to support vendor-related authorizations and strengthen collaboration between the Utilization Management department and external vendors.

The role requires an Associate's Degree in Nursing with 2–3 years of utilization review experience and familiarity with InterQual or Milliman. RN license in Massachusetts is required; Bachelor’s degree is preferred. This is a full-time, day-shift position in Somerville, MA.

Qualifications

• Associate's Degree in Nursing is required; Bachelor’s in Nursing preferred.
• 2–3 years of utilization review experience preferred.
• Experience using InterQual or Milliman preferred.
• At least 1–2 years in a payer setting preferred.
• At least 1–2 years in an acute care setting preferred.

Responsibilities

• Process and manage vendor authorizations.
• Support vendor authorization for reporting issues.
• Maintain authorization code management and ensure appropriate application of UM criteria.
• Assist with the identification, escalation, and resolution of vendor authorization issues.
• Support the review and resolution of UM-related letter concerns.
• Collaborate with vendors and UM leadership to address authorization processing issues and promote operational consistency.

Skills

Utilization review

InterQual

Milliman

Payer setting experience

Acute care experience

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing preferred

Tools

Interqual/Milliman experience

Job description

Mass General Brigham is seeking a Vendor Authorization Specialist, Registered Nurse to support vendor-related authorizations and strengthen collaboration between the Utilization Management department and external vendors.

The role requires an Associate's Degree in Nursing with 2–3 years of utilization review experience and familiarity with InterQual or Milliman. RN license in Massachusetts is required; Bachelor’s degree is preferred. This is a full-time, day-shift position in Somerville, MA.