Utilization Management Transplant Coordinator
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Job Location:
Somerville, NJ - USA
Monthly Salary:
$ 79560 - 115720
Posted on:
7 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
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 providing support to providers facilities and members to ensure streamlined end-to-end transplant coordination. This position will serve as the single point of contact for facilities and providers for members who require transplant support including planning utilization review authorization and post-transplant follow-up.
Candidates must have experience working with provider and/or member-facing organ transplant teams with a demonstrated understanding of the clinical drivers of transplant care and managed care objectives that influence access authorization and delivery of transplant services. This includes the ability to align clinical needs with payer requirements to ensure timely appropriate and compliant services.
The role will track all members across lines of business identified for the transplant program and collaborate closely with Utilization Management Care Management and Medical Director teams to support transplant-specific clinical operational and care coordination needs.
Essential Functions
-In conjunction with other team members ensures that transplant coordination is holistic and managed from end to end.
-Directly interact with providers and their staff to obtain additional clinical information as well as with members or their advocates to understand the full extent of the need to plan transplant activities.
-Review information and provide recommendations to the collaborative team based on analysis of the clinical material.
-Tracks and monitors the status transplant eligible members to ensure comprehensive support and management.
-Coordinates communication between patients healthcare providers and insurance companies regarding discharge needs.
-Obtains appropriate authorizations and tracks each member individually to ensure accuracy in the file and to provide the full support required to coordinate transplant activities.
-Participates in interdisciplinary meetings to discuss complex cases and recommend solutions.
Qualifications
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 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
- At least 2-3 years of transplant management expertise/knowledge 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.
Additional Job Details (if applicable)
Working Conditions
- This is a part-time 20-hour/week position
- The schedule can be flexible within Monday through Friday business hours
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$79560.00 - $115720.80/AnnualGrade
7EEO 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:
IC
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.
