Manager, Medicare and DSNP Utilization ManagementMass General Brigham • Somerville, Massachusetts, United States
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Manager, Medicare and DSNP Utilization Management
Mass General Brigham
- Somerville, Massachusetts, United States
- Somerville, Massachusetts, United States
Über
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 in a related field of study (preferred)
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
Long‑Term Services and Supports (LTSS) experience preferred
At least 2–3 years 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
Excellent communication and interpersonal skills
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
Working Conditions
Remote role; team meets quarterly at Assembly Row, Somerville (attendance encouraged)
Work Location 399 Revolution Drive
Scheduled Weekly Hours 40
Employee Type Regular
Work Shift Day (United States of America)
Pay Range $99,465.60 – $141,804.00 Annual
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 reasonable accommodation for all individuals with a disability 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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Sprachkenntnisse
- English
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