Utilization Management Transitions of Care Coordinator

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

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham we are at the forefront of transformation with one of the worlds leading integrated healthcare systems. Together we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds experiences and skills.

We are pleased to offer competitive salaries and a benefits package with flexible work options career growth opportunities and much more.

The role is an integral part of our clinical coordination team by providing support to providers facilities and members to ensure a streamlined transition process from one level of care to another. This position will be the single point of contact for facilities and providers when a member requires special support when a difficult transition plan is in place or when barriers to obtaining the next level of care arise. This role will track any long-stay members to assist in moving them to the next appropriate level of care. The position collaborates with members of the Utilization Management Appeal and Grievance Care Management and medical director teams to resolve transitional needs

Essential Functions
-In conjunction with other team members ensures that transitional needs and barriers are resolved in a timely manner to meet regulatory timeframes.
-Directly interact with providers and their staff to obtain additional clinical information as well as with members or their advocates to understand the full need to transition a member from one level of care to another.
-Review information and provide recommendations to the collaborative team based on analysis of the clinical material.
-Tracks and monitors the status of long-stay inpatient/post-acute cases ensuring timely discharge planning.
-Identifies trends and patterns in discharge barriers with facilities and providers.
-Coordinates communication between patients healthcare providers and insurance companies regarding discharge needs.
-Coordinates communication with state and federal partners to ensure length of stay reporting is timely and accurate and delivers follow-up information as requested by line of business or regulatory partners.
-Participates in interdisciplinary meetings to discuss complex cases and recommend solutions.

Education

• Associates Degree Nursing required or Bachelors Degree Healthcare Administration required or Bachelors Degree Related Field of Study required

Licenses and Credentials

• Massachusetts Registered Nurse RN license preferred

Experience

• At least 2-3 years of experience in health plan clinical services/utilization management required
• At least 2-3 years of clinical experience required

Knowledge Skills and Abilities

• Strong analytical and critical thinking skills.
• Excellent verbal and written communication abilities.
• Proficient in using electronic health records (EHR) and billing systems.
• Detail-oriented with strong organizational skills.
• Ability to handle sensitive information with confidentiality and professionalism.
• Strong interpersonal skills to work effectively with various stakeholders.

Working Conditions

• This is a remote role that can be done from most US states

Remote

335 Revolution Drive

40

Regular

Day (United States of America)

Pay Range

$79560.00 - $115720.80/Annual

Grade

7

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.

8925 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