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
Supervise clinical care coordinators and case managers
Implement clinical utilization management strategies
Monitor patient care outcomes and regulatory compliance
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 will supervise a team of care coordinators and case managers while implementing best practices to streamline care processes.
  • The position offers competitive salaries, flexible work options, and career growth opportunities within a not-for-profit integrated healthcare system.

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 benefits package with flexible work options and career advancement

Skills & Requirements

Must-have

  • Supervise clinical care coordinators and case managers
  • Implement clinical utilization management strategies
  • Monitor patient care outcomes and regulatory compliance
  • Analyze patient data to identify improvement trends
  • Manage case load assignments based on acuity

Nice-to-have

  • Collaborate with physicians and healthcare providers
  • Implement new care models or technologies
  • Foster a welcoming and supportive team environment
  • Conduct regular performance evaluations and training
  • Ensure accurate documentation of case management activities

Key Requirements

  • Bachelor's Degree required
  • Master's Degree in Related Field of Study preferred
  • Massachusetts Registered Nurse (RN) license required
  • 3-5 years experience in clinical care coordination or case management
  • 2-3 years experience in supervisory or leadership role
  • 2-3 years Medicare and DSNP UM experience required
  • LTSS experience preferred

Work Rights

Not specified

Tailored Resume

Cover Letter