Manager, Medicare and DSNP Utilization Management
Site: Mass General Brigham Incorporated
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.
Essential Functions
-Supervise and support a team of care coordinators and case managers, ensuring they adhere to clinical standards and protocols.
-Develop and implement strategies to enhance the efficiency and effectiveness of clinical care coordination.
-Monitor patient care processes and outcomes to ensure compliance with regulatory requirements and hospital policies.
-Facilitate collaboration between clinical teams, physicians, and other healthcare providers to optimize patient care.
-Review and analyze patient data to identify trends, areas for improvement, and opportunities for intervention.
-Conduct regular performance evaluations and provide ongoing training and development for staff members.
-Manage case load assignments and prioritize patient cases based on acuity and resource availability.
-Oversee the implementation of new care models or technologies to improve patient care and operational efficiency.
-Ensure accurate documentation and reporting of case management activities and patient care outcomes.Remote399 Revolution Drive40RegularDay (United States of America)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 Veteran’s 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 (857)-282-7642.
Apply To This Job
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.
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.
Job Summary
Responsible for overseeing clinical utilization management (UM) activities to ensure efficient use of resources for Medicare Advantage and DSNP members. Manages a team of clinical professionals, implements best practices, and collaborates with various departments to improve patient outcomes and streamline care processes.Essential Functions
-Supervise and support a team of care coordinators and case managers, ensuring they adhere to clinical standards and protocols.
-Develop and implement strategies to enhance the efficiency and effectiveness of clinical care coordination.
-Monitor patient care processes and outcomes to ensure compliance with regulatory requirements and hospital policies.
-Facilitate collaboration between clinical teams, physicians, and other healthcare providers to optimize patient care.
-Review and analyze patient data to identify trends, areas for improvement, and opportunities for intervention.
-Conduct regular performance evaluations and provide ongoing training and development for staff members.
-Manage case load assignments and prioritize patient cases based on acuity and resource availability.
-Oversee the implementation of new care models or technologies to improve patient care and operational efficiency.
-Ensure accurate documentation and reporting of case management activities and patient care outcomes.
Qualifications
Education
- Bachelor's Degree required
- Master's Degree Related Field of Study
Licenses and Credentials
- Massachusetts Registered Nurse [RN] license required
Experience
- At least 3-5 years of experience in clinical care coordination or case management required
- At least 2-3 years of experience in a supervisory or leadership role required
- At least 2-3 years of Medicare and DSNP UM experience required
Knowledge, Skills, and Abilities
- Strong leadership and team management skills to effectively guide and support clinical staff.
- Excellent communication and interpersonal skills to collaborate with healthcare providers and patients.
- Analytical skills to assess patient care data and identify areas for improvement.
- Problem-solving abilities to address complex care coordination issues and implement effective solutions.
- Knowledge of regulatory requirements and industry best practices in clinical care and case management.
- Proficiency in healthcare management software and electronic health record systems.
Additional Job Details (if applicable)
Working Conditions
While a remote role, this team meets every quarter at the office at Assembly Row in Somerville and attendance is highly encouraged.
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$99,465.60 - $141,804.00/Annual
Grade
8
EEO 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.