Manager Utilization Review

Title: Manager Utilization Review

Location: Somerville United States

Job Description:

Site: Mass General Brigham Incorporated

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.

The Opportunity

Manages a department of utilization review professionals usually consisting of Registered Nurses, Social Workers and other paraprofessional roles. Develops and oversees policies and processes for the team and collaborates with other departments to improve the organization's utilization.

Job Summary

Primary Responsibilities:

• Manages team and related staff, including hiring, training, supervision, and performance management.
• Participates in policy and procedure review and development.
• Protects healthcare organization value by keeping information confidential, cautioning others regarding potential breaches.
• Maintains awareness of health insurance changes.
• Maintains compliance with regulation changes affecting utilization management.

Qualifications

What You'll Bring

Qualification Requirements:

• Bachelor's Degree Nursing

• Registered Nurse (RN) license

• 3+ years of Utilization Review experience

• 2+ years management experience

Preferred Skills:

• Master's Degree Nursing

• Change management experience

• Integration experience

• Workday, UKG, Epic, NCG and/or InterQual experience

• Medical Necessity Appeals and Denials experience

• Peer to Peer experience

Additional Knowledge, Skills and Abilities:

• Excellent team communication skills.

• Strong interpersonal skills, with the ability to develop, motivate and inspire a team.

• Strong team player that is able to multitask with multiple interruptions in a deadline-intense environment.

• Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.

• Understanding the implications of new information for both current and future problem-solving and decision-making.

Additional Job Details (if applicable)

Schedule and Work Model

• Remote

• Full-time (40 hours) Monday through Friday, standard business hours with minimal weekend coverage

• Employees must use a stable, secure, and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment.

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$58,656.00 - $142,448.80/Annual

Grade

98TEMP

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 package. In 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.

EEO Statement:

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. 

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.