Key Facts

Remote From:

Full time

Expert & Leadership (>10 years)

English

Hard Skills

Utilization Management Care Coordination Discharge Planning Care Coordination Discharge Planning Medical Devices Electronic Health Record Applications Regulatory Compliance Billing Insurance Regulatory Law Inpatient Care Acute Care Nursing Clinical Documentation Grievance Arbitration Online Communication Sensitive Security Information Stakeholder Communications

Other Skills

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Non-Verbal Communication
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Analytical Skills
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Teamwork
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Critical Thinking
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Organizational Skills
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Detail Oriented
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Social Skills
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Problem Solving

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 Health Plan Holding Company, Inc.

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.

Job Summary

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.

The role is an integral part of our clinical coordination team by providing support to providers, facilities, and members to ensure a streamlined transition process from one level of care to another. This position will be the single point of contact for facilities and providers when a member requires special support, when a difficult transition plan is in place, or when barriers to obtaining the next level of care arise. This role will track any long-stay members to assist in moving them to the next appropriate level of care. The position collaborates with members of the Utilization Management, Appeal and Grievance, Care Management, and medical director teams to resolve transitional needs

Essential Functions
-In conjunction with other team members, ensures that transitional needs and barriers are resolved in a timely manner to meet regulatory timeframes.
-Directly interact with providers and their staff to obtain additional clinical information, as well as with members or their advocates to understand the full need to transition a member from one level of care to another.
-Review information and provide recommendations to the collaborative team based on analysis of the clinical material.
-Tracks and monitors the status of long-stay inpatient/post-acute cases, ensuring timely discharge planning.
-Identifies trends and patterns in discharge barriers with facilities and providers.
-Coordinates communication between patients, healthcare providers, and insurance companies regarding discharge needs.
-Coordinates communication with state and federal partners to ensure length of stay reporting is timely and accurate, and delivers follow-up information, as requested, by line of business or regulatory partners.
-Participates in interdisciplinary meetings to discuss complex cases and recommend solutions.

Qualifications

Education

Associate's Degree Nursing required or Bachelor's Degree Healthcare Administration required or Bachelor's Degree Related Field of Study required

Licenses and Credentials

Massachusetts Registered Nurse [RN] license preferred

Experience

At least 2-3 years of experience in health plan clinical services/utilization management required
At least 2-3 years of clinical experience required

Knowledge, Skills, and Abilities

Strong analytical and critical thinking skills.
Excellent verbal and written communication abilities.
Proficient in using electronic health records (EHR) and billing systems.
Detail-oriented with strong organizational skills.
Ability to handle sensitive information with confidentiality and professionalism.
Strong interpersonal skills to work effectively with various stakeholders.

Additional Job Details (if applicable)

Working Conditions

This is a remote role that can be done from most US states

Remote Type

Remote

Work Location

335 Revolution Drive

Scheduled Weekly Hours

Employee Type

Regular

Work Shift

Day (United States of America)

Pay Range

$79,560.00 - $115,720.80/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:

8925 Mass General Brigham Health Plan Holding Company, Inc. 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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