Manager, Medicare Advantage Coordinated Care
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Job Location:
Somerville, NJ - USA
Monthly Salary:
$ 99465 - 141804
Posted on:
3 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.
Responsible for providing leadership and oversight for care coordination and case management services within MGB Health Plans Medicare Advantage line of business. This role ensures effective patient-centered coordination of care across the continuum supporting quality outcomes safe transitions and appropriate utilization of resources. The manager collaborates closely with interdisciplinary teams to improve care delivery and promote best practices in case management discharge planning and population health.
Essential Functions
-Oversee daily operations of care coordination and case management teams including registered nurses social workers and support staff.
-Ensure timely and effective coordination of patient care plans including discharge planning transition of care and resource referrals.
-Monitor workflows to support appropriate utilization review medical necessity determinations and regulatory compliance.
-Collaborate with clinical leadership physicians and external providers to resolve barriers to care and optimize patient flow.
-Develop and maintain policies procedures and workflows that align with industry standards payer requirements and internal goals.
-Manage performance metrics including readmission rates length of stay denial rates and patient satisfaction outcomes.
-Facilitate staff education training and professional development support certification in case management and care transitions.
-Represent care coordination in interdisciplinary committees quality improvement initiatives and accreditation readiness efforts.
-Ensure compliance with CMS Joint Commission and other applicable regulations and standards.
Qualifications
Education
- Bachelors Degree required
- Masters Degree preferred
Licenses and Credentials
- Massachusetts Registered Nurse (RN) required
Experience
- At least 5-7 years of experience in care coordination case management or discharge planning in a healthcare setting required
- At least 2-3 years of experience in a supervisory or leadership required
- At least 1-2 years of experience with utilization review value-based care population health managed care principles transitional care models and interdisciplinary care planning preferred
- Experience working for a health plan supporting its Medicare Advantage line of business highly preferred
- Experience preparing for CMS audits highly preferred
Knowledge Skills and Abilities
- In-depth knowledge of case management standards patient care coordination strategies and healthcare regulations.
- Strong leadership team-building and staff development skills.
- Excellent communication problem-solving and negotiation abilities.
- Ability to analyze data identify trends and implement process improvements.
- Proficiency in electronic health records (EHRs) case management systems and reporting tools.
Additional Job Details (if applicable)
Working Conditions
- This is a hybrid role with occassional office visits (a few times/quarter)
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.
