Supervisor, Utilization Management

Site: Mass General Brigham Incorporated

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

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Job Summary

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. 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 system, 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 serveour members, providers, brokers, and employersfront 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.
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.
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:

• Bachelors 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.
• Clinical license required (RN).
• Certified Case Manager preferred.
• Strong leadership skills preferred.

Skills/Abilities/Competencies:

• Demonstrate Mass General Brigham Health Plans core brand principles of always listening, challenging conventions, and providing value.
• Bring fresh ideas forward by listening to and working with employees and the people we serve.
• Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.
• Strong, demonstrated track record of an ability to execute on time, on budget, and on scope.
• Strong aptitude for technology-based solutions.
• Ability to inject energy, when and where its needed.
• Current in healthcare trends.
• Demonstrated forward, visionary thinking; ability to see what is and envision what could be.
• Ability to develop, introduce, defend, and gain support for a new ideas and approaches.
• Excellent leadership skills and leadership track record.
• Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.
• Ability to view the long-range trends and cycles of the business and industry and see the big picture.
• Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
• Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy.
• Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
• Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
• Unquestionable integrity.

Additional Job Details (if applicable)

Working Conditions

• While a remote role, this team meets every quarter at the office at Assembly Row in Somerville and attendance is highly encouraged.

Remote Type

Remote

Work Location

399 Revolution Drive

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$97,510.40 - $141,804.00/Annual

Grade

8At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

EEO Statement:

Mass General Brigham Incorporated is an Equal Opportunity Employer. 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at .... Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership looks like by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.