Medicare Utilization Management Supervisor
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Job Location:
Somerville, NJ - USA
Monthly Salary:
$ 99465 - 141804
Posted on:
6 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 supervisor will work closely with the Manager of Clinical to oversee the daily operations of roughly 5 Medicare Advantage 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 needs
Essential 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 MedAdv 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 Related Field of Study required (experience can be considered in lieu of a degree)
Licenses and Credentials
- Massachusetts Registered Nurse (RN) license
- Certified Case Manager CCM preferred
Experience
- At least 3-5 years of relevant experience in managed care setting with 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
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$99465.60 - $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
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.
