Site: Mass General Brigham Health Plan Holding Company Inc.
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 Medicare UM Case Manager RN performs utilization management activities primarily for Medicare Advantage including review of authorizations for home care high tech radiology outpatient inpatient and post-acute services. The Medicare UMCM reviews the medical necessity of authorization requests using NCD LCD Medicare Benefit Policy Manual medical policies and InterQual criteria.
Education
- Associates Degree Nursing required; Bachelors Degree Nursing preferred
Licenses and Credentials
- Massachusetts Registered Nurse license required
- Basic Life Support BLS Certification Certification preferred
Experience
- At least 2-3 years of utilization management strongly preferred
- Experience applying National Coverage Determinations (NCD) Local Coverage Determinations (LCD) and Medicare Benefit Policy Manual preferred
- InterQual experience preferred
Knowledge Skills and Abilities
- Giving full attention to what other people are saying taking time to understand the points being made asking questions as appropriate and not interrupting at inappropriate times.
- Using logic and reasoning to identify the strengths and weaknesses of alternative solutions conclusions or approaches to problems.
- Ability to establish strong rapport and relationships with patients and staff.
- Proficient in Microsoft Office and industry-related software programs.
- Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
- Ability to maintain client and staff confidentiality.
- Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care.
- Knowledge of Healthcare and Managed Care preferred.
Additional Job Details (if applicable)
Working Conditions
- This is a remote role that can be done from most US states
Remote
399 Revolution Drive
40
Regular
Day (United States of America)
Pay Range
$58656.00 - $142448.80/Annual
Grade
98TEMP
At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
Mass General Brigham Health Plan Holding Company Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .
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:
IC
Site: Mass General Brigham Health Plan Holding Company Inc.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 com...
Site: Mass General Brigham Health Plan Holding Company Inc.
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 Medicare UM Case Manager RN performs utilization management activities primarily for Medicare Advantage including review of authorizations for home care high tech radiology outpatient inpatient and post-acute services. The Medicare UMCM reviews the medical necessity of authorization requests using NCD LCD Medicare Benefit Policy Manual medical policies and InterQual criteria.
Education
- Associates Degree Nursing required; Bachelors Degree Nursing preferred
Licenses and Credentials
- Massachusetts Registered Nurse license required
- Basic Life Support BLS Certification Certification preferred
Experience
- At least 2-3 years of utilization management strongly preferred
- Experience applying National Coverage Determinations (NCD) Local Coverage Determinations (LCD) and Medicare Benefit Policy Manual preferred
- InterQual experience preferred
Knowledge Skills and Abilities
- Giving full attention to what other people are saying taking time to understand the points being made asking questions as appropriate and not interrupting at inappropriate times.
- Using logic and reasoning to identify the strengths and weaknesses of alternative solutions conclusions or approaches to problems.
- Ability to establish strong rapport and relationships with patients and staff.
- Proficient in Microsoft Office and industry-related software programs.
- Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
- Ability to maintain client and staff confidentiality.
- Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care.
- Knowledge of Healthcare and Managed Care preferred.
Additional Job Details (if applicable)
Working Conditions
- This is a remote role that can be done from most US states
Remote
399 Revolution Drive
40
Regular
Day (United States of America)
Pay Range
$58656.00 - $142448.80/Annual
Grade
98TEMP
At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.
Mass General Brigham Health Plan Holding Company Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .
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:
IC
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Job Location:
Monthly Salary:
$ 58656 - 142448
Posted on:
Yesterday
Vacancies:
1 Vacancy
