Vendor Authorization Specialist, Registered Nurse

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Mass General Brigham Health Plan Holding Company, Inc.

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.

Given equity, this position will pay somewhere between $90,000 to $107,000 annually.

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 world's 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.

This role will be responsible for supporting vendor-related authorizations and ensuring effective collaboration between the Utilization Management (UM) department and vendors.

• Processing and managing vendor authorizations.
• Supporting vendor authorization for reporting issues.
• Maintaining authorization code management and ensuring the appropriate application of UM criteria.
• Assisting with the identification, escalation, and resolution of vendor authorization issues.
• Supporting the review and resolution of UM-related letter concerns.
• Collaborating with vendors and UM leadership to address authorization processing issues and promote operational consistency

• Associate's Degree Nursing required or Bachelor's Degree Nursing preferred

• Massachusetts Registered Nurse (RN) license required

• At least 2-3 years of utilization review experience is highly preferred
• Experience using Interqual or Milliman is highly preferred
• At least 1-2 years of experience in a payer setting is highly preferred
• At least 1-2 years of experience in an acute care setting is highly preferred

• Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value
• Strong aptitude for technology-based solutions.
• Embrace opportunities to take the complexity out of how we work and what we deliver.
• Listen to our constituents, learn, and act quickly in our ongoing pursuit of meaningful innovation
• Current in healthcare trends.
• Ability to inject energy, when and where it's needed.
• Exercise self-awareness; monitor impact on others; be receptive to and seek out feedback; use self-discipline to adjust to feedback.
• Be accountable for delivering high-quality work. Act with a clear sense of ownership.
• Bring fresh ideas forward by actively listening to and working with employees and the people we serve.
• Communicate respectfully and professionally with colleagues
• Strong EQ; exercises self-awareness; monitors impact on others; is receptive and seeks out feedback; uses self-discipline to adjust to feedback.

• Would need to be available for "on call" for a minimum of once per month with the possibility of that increasing depending on staff availability;
  Approximately 6 months after hire.
• This is a remote role with occasional onsite team meetings in Somerville, MA.
• Monday through Friday, eastern business hours required
• Remote workdays require a stable, secure, quiet, and HIPAA-compliant workspace. This will be confirmed via Microsoft Teams video for all employees

Given equity, this position will pay somewhere between $90,000 to $107,000 annually.

Remote

399 Revolution Drive

40

Regular

Day (United States of America)

$58,656.00 - $/Annual

98

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