Supervisor, Utilization Management
Mass General Brigham Health Plan

Job Info

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This is a remote role with occasional (roughly 1x/every other month) onsite team meetings in Somerville, MA.

The Supervisor will work closely with the Utilization Manager of Clinical Services to oversee the daily operations of the Utilization Staff. The incumbent will be responsible for the direct coaching, supervision, and evaluation of licensed clinical staff members. The incumbent may at times be required to participate in projects across the organization for new products or business needs.

Principal Duties and Responsibilities:

• Expertise in clinical inpatient and outpatient utilization management reviews utilizing InterQual®, company policies and procedures, and other resources as determined by review, including physician reviews as needed
• Expertise in clinical inpatient and outpatient care
• Demonstrated leadership skills to influence and motivate a team, team-building skills, and performance coaching
• Ability to organize and effectively manage meetings
• Proficient with Microsoft Word, Excel, Outlook, McKesson InterQual ®, Outlook, SharePoint, PC-based operating systems, and web-based phone system
• Excellent verbal, written, listening, and interpersonal skills
• Ability to efficiently prioritize and organize work
• Ability to be creative, develop solutions for problem-solving, and utilize critical thinking skills
• Strong internal and external customer focus
• Demonstrated commitment to increasing customer satisfaction
• Demonstrated collaborative working efforts within UM department and external business partners
• Ability to follow directions and work with minimal direct supervision
• Sound decision making and time management skills
• Proactive in areas of professional development personally and for the department
• Outstanding project management skills and techniques

Core Functions:

Staff Supervision
• 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, quality reviews, ensure timeliness, and equitable distribution of cases
• Report staff productivity trends and any other department/staff concerns to manager as needed
• Promote staff growth and development.
• Lead staff orientation and training within the UM department as needed
• Staff performance management, conduct 1:1 meeting with staff.
• Regular internal and external communication on a team and individual basis
• Oversee compliance and timeliness of authorizations and denial letters.
• Participate in and lead agile groups.
• Participate in and lead quality improvement initiatives within the clinical operations department.
• Participate in monthly audits, providing feedback to staff as opportunities for improvement as identified.

Infrastructure Enhancement
• Participate in system enhancement planning & development
• Policy & Procedure implementation and maintenance
• 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 w MA regulations and Mass General Brigham Health Plan goals as needed
• Develop tools and workflows to ensure accuracy and completeness of reviews and documentation
• Participate in inter-departmental meetings
• Inform, engage, inspire, motivate, and actively listen to employees.
• Make decisions that put the needs of the people we serve-our members, providers, brokers, and employers-front and center.
• Communicate and cascade information to employees in a timely manner and actively participate in the success of cross-organizational programs and initiatives.
• Identify/create processes and align resources to accomplish key objectives; clearly convey and assign clear accountability for important objectives, deadlines, and expectations.
• Hire, participate in, and/or recommend development measures and disciplinary actions up to and including termination; evaluate performance and supervise the work of all direct and indirect reports following established organizational policies, procedures, and practices.
• Set clear goals and objectives, use metrics to measure performance, and hold employees accountable. Provide coaching to improve performance and holds regular development meetings.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Hold self and others accountable to meet commitments.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles or setbacks.
• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
• Hold self and others accountable to meet commitments.
• Ensure diversity, equity, and inclusion are integrated as a guiding principle.
• Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
• Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
• Other duties as assigned with or without accommodation.

Qualifications
Qualifications:

• Bachelor's degree required or the equivalent combination of training and experience, plus 4 years of related experience in a managed care setting, knowledge of utilization management (i.e. insurance company), leading or management of a team.
• Massachusetts RN license required
• Certified Case Manager preferred.
• Strong leadership skills preferred.

About Us:

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

EEO Statement
Mass General Brigham Health Plan 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.

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