Key Facts

Remote From:

Full time

Mid-level (2-5 years)

English

Hard Skills

Care Coordination Case Management Systems Documentation Generation Industry Trend Analysis Case Management Systems Performance Management Analytics Regulatory Compliance Care Management Quality Assessment Cross-Functional Collaboration Patient Monitoring Resource Management Electronic Health Record Applications Biomedical Instrumentation Clinical Practices Stakeholder Communications

Other Skills

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Team Leadership
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Visual Acuity
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Training And Development
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Communication
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Teamwork
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Analytical Thinking
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Prioritization
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Social Skills
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Problem Solving

Roles & Responsibilities

Bachelor's Degree required
Master's Degree in a related field of study
Massachusetts RN license required
3-5 years of clinical care coordination or case management experience, including 2-3 years in a supervisory/leadership role, and 2-3 years of Medicare and DSNP UM experience

Requirements:

Supervise and support a team of care coordinators and case managers, ensuring they adhere to clinical standards and protocols
Develop and implement strategies to enhance the efficiency and effectiveness of clinical care coordination
Monitor patient care processes and outcomes to ensure compliance with regulatory requirements and hospital policies
Oversee the implementation of new care models or technologies to improve patient care and operational efficiency

Brigham and Women's Hospital

About Brigham and Women's Hospital

Boston's Brigham and Women's Hospital (BWH) is an international leader in virtually every area of medicine and has been the site of pioneering breakthroughs that have improved lives around the world. A major teaching hospital of Harvard Medical School, BWH has a legacy of excellence that continues to grow. With two outstanding hospitals, over 150 outpatient practices, and over 1,200 physicians, we serve patients from New England, throughout the United States, and from 120 countries around the world. The BWH name is a reflection of our history. In 1980 three of Boston’s oldest and most prestigious Harvard Medical School teaching hospitals - the Peter Bent Brigham Hospital, the Robert Breck Brigham Hospital, and the Boston Hospital for Women – merged to form Brigham and Women’s Hospital. As a national leader in improving health care quality and safety, we have helped to develop some of the industry’s best practices including computerized physician order entry (CPOE) to prevent medication errors. The CPOE is now a nationally-accepted safety practice. The BWH Biomedical Research Institute (BRI) is one of the most powerful biomedical research institutes in the world and the second largest recipient of National Institutes of Health (NIH) funding among independent hospitals in the United States. BWH has long had great success in research as measured by the number of important discoveries made, the size and scope of its research portfolio and the volume of publications annually. BWH is a training ground for physicians, nurses, and allied health professionals. We have 1,100 trainees in over 140 of the most sought after training programs in the world, and also host Harvard Medical School students in rotations throughout our programs. As our global health services expand, our clinical trainees have rich opportunities to contribute and learn in challenging environments around the world. Brigham and Women's Hospital is an EEO, AA, VEVRAA Employer.

Founded: 2018

Company size: 10001

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Job description

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.

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are at 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 welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills.

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

Job Summary

Responsible for overseeing clinical utilization management (UM) activities to ensure efficient use of resources for Medicare Advantage and DSNP members. Manages a team of clinical professionals, implements best practices, and collaborates with various departments to improve patient outcomes and streamline care processes.

Essential Functions
-Supervise and support a team of care coordinators and case managers, ensuring they adhere to clinical standards and protocols.
-Develop and implement strategies to enhance the efficiency and effectiveness of clinical care coordination.
-Monitor patient care processes and outcomes to ensure compliance with regulatory requirements and hospital policies.
-Facilitate collaboration between clinical teams, physicians, and other healthcare providers to optimize patient care.
-Review and analyze patient data to identify trends, areas for improvement, and opportunities for intervention.
-Conduct regular performance evaluations and provide ongoing training and development for staff members.
-Manage case load assignments and prioritize patient cases based on acuity and resource availability.
-Oversee the implementation of new care models or technologies to improve patient care and operational efficiency.
-Ensure accurate documentation and reporting of case management activities and patient care outcomes.

Qualifications

Education

Bachelor's Degree required
Master's Degree Related Field of Study

Licenses and Credentials

Massachusetts Registered Nurse [RN] license required

Experience

At least 3-5 years of experience in clinical care coordination or case management required
At least 2-3 years of experience in a supervisory or leadership role required
At least 2-3 years of Medicare and DSNP UM experience required

Knowledge, Skills, and Abilities

Strong leadership and team management skills to effectively guide and support clinical staff.
Excellent communication and interpersonal skills to collaborate with healthcare providers and patients.
Analytical skills to assess patient care data and identify areas for improvement.
Problem-solving abilities to address complex care coordination issues and implement effective solutions.
Knowledge of regulatory requirements and industry best practices in clinical care and case management.
Proficiency in healthcare management software and electronic health record systems.

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

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$99,465.60 - $141,804.00/Annual

Grade

At 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:

0100 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 Veteran’s 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 (857)-282-7642.

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.

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