Manager Utilization Review

Somerville, NJ - USA

Monthly Salary: $ 58656 - 142448

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

Site: Mass General Brigham Incorporated

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.

The Opportunity

Compensation offered for this position is up to $200k dependent on level of experience.

Manages a department of utilization review professionals usually consisting of Registered Nurses Social Workers and other paraprofessional roles. Develops and oversees policies and processes for the team and collaborates with other departments to improve the organizations utilization.

Job Summary

Primary Responsibilities:

-Manages team and related staff including hiring training supervision and performance management.
-Participates in policy and procedure review and development.
-Protects healthcare organization value by keeping information confidential cautioning others regarding potential breaches.
-Maintains awareness of health insurance changes.
-Maintains compliance with regulation changes affecting utilization management.

Qualifications

What Youll Bring

Qualification Requirements:

Bachelors Degree Nursing
Registered Nurse (RN) license
3 years of Utilization Review experience
2 years management experience

Preferred Skills:

Masters Degree Nursing
Change management experience
Integration experience
Workday UKG Epic NCG and/or InterQual experience
Medical Necessity Appeals and Denials experience
Peer to Peer experience

Additional Knowledge Skills and Abilities:

Excellent team communication skills.
Strong interpersonal skills with the ability to develop motivate and inspire a team.
Strong team player that is able to multitask with multiple interruptions in a deadline-intense environment.
Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
Understanding the implications of new information for both current and future problem-solving and decision-making.

Additional Job Details (if applicable)

Schedule and Work Model

Remote
Full-time (40 hours) Monday through Friday standard business hours with minimal weekend coverage
Employees must use a stable secure and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment.

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

Employee Type

Regular

Work Shift

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.

EEO Statement:

0100 Mass General Brigham Incorporated 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:

Manager

Site: Mass General Brigham IncorporatedMass 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 striv...