Dsnp Utilization Management Nurse

Mass General Brigham Health Plan Holding Company, Inc.

Unknown, USA
Base: $90,000 to $107,000 annually; bonus/equity: ...
Fully remote
Medicare advantage utilization review
Medical necessity review
Ncd, lcd, medicare benefit policy manual
Mass General Brigham Health Plan is at the forefront of transformation within the healthcare industry, providing innovative solutions centered on member health needs

Job Summary

  • Mass General Brigham Health Plan is at the forefront of transformation within the healthcare industry, providing innovative solutions centered on member health needs.
  • The Medicare UM Nurse performs utilization management activities primarily for Medicare Advantage, reviewing authorizations for various services against established criteria.
  • The organization offers competitive salaries, comprehensive benefits, flexible work options, and career growth opportunities within a welcoming and supportive environment.

Matching Summary

Mass General Brigham Health Plan is at the forefront of transformation within the healthcare industry, providing innovative solutions centered on member health needs.

Salary

Base: $90,000 to $107,000 annually; Bonus/Equity: Not specified; Benefits: Comprehensive benefits package

Skills & Requirements

Must-have

  • Medicare Advantage utilization review
  • Medical necessity review
  • NCD, LCD, Medicare Benefit Policy Manual
  • InterQual criteria
  • Microsoft Office proficiency

Nice-to-have

  • Strong rapport building skills
  • Confidentiality maintenance
  • Dual conditions understanding
  • Continuum of care conceptualization

Key Requirements

  • Associate's Degree Nursing required
  • Bachelor's Degree Nursing preferred
  • Massachusetts Registered Nurse license required
  • Basic Life Support Certification preferred
  • 2-3 years utilization management experience
  • Experience applying NCD, LCD, Medicare Benefit Policy Manual
  • InterQual experience preferred

Work Rights

Not specified

Tailored Resume

Cover Letter