Utilization Management Care Manager

Mass General Brigham Health Plan Holding Company, Inc.

Somerville, MA, United States
Base: $58,656.00 - $142,448.80/annual; bonus/equit...
Fully remote
Massachusetts registered nurse license required
Interqual or milliman utilization review experience
Managed care setting prior authorization experience
The Mass General Brigham Health Plan is seeking a Utilization Management Care Manager to work remotely, focusing on clinical review and decision-making related to medical service authorization. The ideal candidate should have experience in utilization review, particularly in a managed care setting, and a background in nursing

Job Summary

  • The role involves utilizing clinical knowledge to analyze, assess, and render approval decisions for physician reviews and coverage determinations.
  • Candidates must possess expertise in prospective, concurrent, and retrospective utilization management reviews using Interqual and company policies.
  • The position offers competitive salaries, flexible work options, and career growth opportunities within a welcoming and supportive environment.

Matching Summary

Match Score: 85

The Mass General Brigham Health Plan is seeking a Utilization Management Care Manager to work remotely, focusing on clinical review and decision-making related to medical service authorization. The ideal candidate should have experience in utilization review, particularly in a managed care setting, and a background in nursing.

Salary

Base: $58,656.00 - $142,448.80/Annual; Bonus/Equity: Not specified; Benefits: Comprehensive benefits package with flexible work options

Skills & Requirements

Must-have

  • Massachusetts Registered Nurse License required
  • Interqual or Milliman utilization review experience
  • Managed care setting prior authorization experience

Nice-to-have

  • Strong problem-solving and customer service skills
  • Ability to multi-task in a self-directed manner
  • Experience with commercial and self-insured plans

Key Requirements

  • Associate's Degree Nursing required or Bachelor's Degree Nursing preferred
  • 2-3 years of utilization review experience highly preferred
  • 1-2 years of experience in a payer setting highly preferred
  • 1-2 years of experience in an acute care setting highly preferred

Work Rights

Not specified

Tailored Resume

Cover Letter