Manager, Medicare And Dsnp Utilization Management

Mass General Brigham Health Plan Holding Company, Inc.

Somerville, MA, United States
Base: $99,465.60 - $141,804.00/annual; bonus/equit...
Fully remote
Clinical utilization management oversight
Medicare advantage and d-snp experience
Team supervision of care coordinators
The role is responsible for overseeing clinical utilization management activities to ensure efficient resource use for Medicare Advantage and D-SNP members

Job Summary

  • The role is responsible for overseeing clinical utilization management activities to ensure efficient resource use for Medicare Advantage and D-SNP members.
  • Candidates must supervise a team of care coordinators and case managers while ensuring adherence to clinical standards and protocols.
  • Mass General Brigham offers competitive salaries, comprehensive benefits, and flexible work options including a remote position with quarterly office meetings.

Matching Summary

The role is responsible for overseeing clinical utilization management activities to ensure efficient resource use for Medicare Advantage and D-SNP members.

Salary

Base: $99,465.60 - $141,804.00/Annual; Bonus/Equity: Not specified; Benefits: Comprehensive package with flexible work options and career growth opportunities

Skills & Requirements

Must-have

  • Clinical utilization management oversight
  • Medicare Advantage and D-SNP experience
  • Team supervision of care coordinators
  • Long-Term Services and Supports knowledge
  • Regulatory compliance monitoring

Nice-to-have

  • Innovative healthcare solutions implementation
  • Collaboration with diverse healthcare providers
  • Data-driven improvement strategies
  • Welcoming and supportive team environment
  • Flexible work options availability

Key Requirements

  • Bachelor's degree required; Master's preferred in related field
  • Massachusetts Registered Nurse (RN) license required
  • 3-5 years clinical care coordination or case management experience
  • 2-3 years supervisory or leadership role experience
  • 2-3 years Medicare and DSNP UM experience required

Work Rights

Not specified

Tailored Resume

Cover Letter