What are the responsibilities and job description for the Manager, Utilization Review position at Mass General Brigham?
At Mass General Brigham, we know it takes a surprising range of talented professionals to advance our mission—from doctors, nurses, business people and tech experts, to dedicated researchers and systems analysts. As a not-for-profit organization, Mass General Brigham is committed to supporting patient care, research, teaching, and service to the community. We place great value on being a diverse, equitable and inclusive organization as we aim to reflect the diversity of the patients we serve.
At Mass General Brigham, we believe a diverse set of backgrounds and lived experiences makes us stronger by challenging our assumptions with new perspectives that can drive revolutionary discoveries in medical innovations in research and patient care. Therefore, we invite and welcome applicants from traditionally underrepresented groups in healthcare — people of color, people with disabilities, LGBTQ community, and/or gender expansive, first and second-generation immigrants, veterans, and people from different socioeconomic backgrounds – to apply.
Support the new centralization of UM and will manage the AMC hospitals
Job Summary
The Manager of Utilization Review is accountable for the delivery of consistent, high-quality patient care, promoting the development and satisfaction of Utilization Review nurses and support staff, providing operational efficiencies and insuring compliance with hospital and utilization management regulatory policies and standards of practice. The Manager of Utilization Review develops and implements department initiatives to enhance the evolving role of the Utilization Management.The Manager of Utilization Review provides leadership across multiple hospitals within the system. The role ensures patient-focused Utilization Management standards of practice, personnel management and development, and fiscal responsibility. In addition to daily operations, the role maintains and cultivates partnerships with numerous clinical and non-clinical services/departments within the organization through participation in Case Management, Revenue Cycle, Contracting, and MGB Payer groups, committees and initiatives.
Qualifications
Qualifications:
Bachelor's Degree in Nursing required, Master's Degree in Nursing or Social Work preferred. Registered Nurse [RN - State License]
3-5 years utilization review experience required
2-3 years leadership experience required
Knowledge, Skills and Abilities:
Excellent team communication skills.
Strong interpersonal skills, with the ability to develop, motivate and inspire a team.
Strong team player that is able to multitask with multiple interruptions in a deadline-intense environment.
Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
Understanding the implications of new information for both current and future problem-solving and decision-making.
Additional Job Details (if applicable)
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
EEO Statement:
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.
