Supervisor, Utilization Management

The supervisor will work closely with the Manager, Clinical, to oversee the daily operations of the 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.

• Expertise in clinical inpatient and outpatient utilization management reviews utilizing Inter Qual, 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 MA regulations and Mass General Brigham Health Plan goals as needed.
• Develop tools and workflows to ensure accuracy and completeness of reviews and documentation.

• Bachelor's Degree required or the equivalent combination of training and experience

• MA Registered Nurse (RN) license required
• Certified Case Manager [CCM] preferred

• At least 3-5 years of relevant experience in managed care setting, knowledge of utilization management required
• Expertise in clinical inpatient and outpatient care required
• Leadership and/or supervisory experience preferred

• Proficient user with Microsoft Office and McKesson Inter Qual.
• Excellent verbal, written, listening, and interpersonal skills.
• Demonstrate Mass General Brigham Health Plan's core brand principles of always listening, challenging conventions, and providing value.

• While a remote role, this team meets every quarter at the office at Assembly Row in Somerville and attendance is highly encouraged.

Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.