Supervisor, Utilization Management
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Job Location:
Somerville, NJ - USA
Monthly Salary:
$ 97510 - 141804
Posted on:
2 days ago
Vacancies:
1 Vacancy
Job Summary
Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
The supervisor will work closely with the Manager Clinical to oversee the daily operations of the utilization management staff. The supervisor will be responsible for the direct coaching supervision and evaluation of licensed clinical staff. The supervisor may be required to participate in projects across the organization to support new products or address business needsEssential Functions
-Expertise in clinical inpatient and outpatient utilization management reviews utilizing InterQual company policies and procedures and other resources as determined by review including physician reviews as needed.
-Educate staff on quality review requirements and documentation guidelines with emphasis on highly accurate and specific documentation consistent with national regulations and practice.
-Monitor individual productivity and adjust assignments as needed to support productivity goals ensure quality reviews maintain timeliness and achieve an equitable distribution of cases.
-Report staff productivity trends and any other department/staff concerns to the manager as needed.
-Ensure site assignments phone/fax lists hospital reports etc. are updated and accurate.
-Monthly review of staff roles metrics and quality of work making readjustments to align with MA regulations and Mass General Brigham Health Plan goals as needed.
-Develop tools and workflows to ensure accuracy and completeness of reviews and documentation.
Qualifications
Education
- Bachelors Degree required or the equivalent combination of training and experience
Licenses and Credentials
- MA Registered Nurse (RN) license required
- Certified Case Manager CCM preferred
Experience
- At least 3-5 years of relevant experience in managed care setting knowledge of utilization management required
- Expertise in clinical inpatient and outpatient care required
- Leadership and/or supervisory experience preferred
Knowledge Skills and Abilities
- Proficient user with Microsoft Office and McKesson InterQual.
- Excellent verbal written listening and interpersonal skills.
- Demonstrate Mass General Brigham Health Plans core brand principles of always listening challenging conventions and providing value.
Additional Job Details (if applicable)
Working Conditions
- While a remote role this team meets every quarter at the office at Assembly Row in Somerville and attendance is highly encouraged.
Remote Type
Work Location
Pay Range
$97510.40 - $141804.00/AnnualGrade
8EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance make hiring decisions identify development needs mobilize employees across our system and establish a strong talent pipeline.
Required Experience:
Manager
Key Skills
- Abinitio
- Lifting Equipment
- Customer Service
- Apache Commons
- Business Management
About Company
Patients at Mass General have access to a vast network of physicians, nearly all of whom are Harvard Medical School faculty and many of whom are leaders within their fields.
