- Location
- 2014 Washington Street Newton (Allen Riddle Building), United States of America
- Workplace
- Remote
- Type
- Part-time
- Department
- Healthcare
- Seniority
- Manager
- Education
- Bachelor
- Source
- Workday
Description
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
Per diem shifts will be variable (Day shift Monday through Friday, holidays and weekends).The essential duties of the Insurance Support-Utilization Case Manager are to act as the department coordinator for all insurance workflows that case managers are responsible for; be the department point person for managing and preventing denials and the department expert for understanding payer rules and regulations. The Insurance support- Utilization Case Manager works closely with care coordination, medical and surgical physicians, nursing staff and other PHS departments that are responsible for billing, compliance, and finance and revenue integrity.
Key areas of responsibilities include managing day to day payer communication as it relates to supporting hospital admissions; providing UR to payers as needed; managing complex billing decisions; identifying payer trends; responding to payer denials; interfacing with other departments that impact billing and denials; educating care coordination staff about utilization management issues, government regulations and other things that impact revenue integrity; and providing reports related to UM as needed.
Qualifications
Qualifications:
Associate's Degree Nursing required or Bachelor's Degree Nursing preferred.
Registered Nurse (RN) License for the State of Massachustetts required.
3+ years of Medical Surgical experience required.
Utilization Review (UR) experience strongly preferred.
Additional Skills for Success:
Giving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
Ability to establish strong rapport and relationships with patients and staff.
Proficient in Microsoft Office and industry related software programs.
Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
Ability to maintain client and staff confidentiality.
Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care.
Knowledge of Healthcare and Managed Care preferred.
Additional Job Details (if applicable)
Working Model and Schedule:
Fully remote
Per Diem shifts will be variable (Days Monday through Friday, holidays and weekends). Must be available to work at least 8 hours per week and will not work more than 24 hours per week.
A quiet, secure, compliant work station is required for remote employees, using MGB Issues equipment.
This role requires employee to reside in New England states (CT, MA, ME, NH, RI, VT) to be eligible for employment at Newton Wellesley Hospital and for this Union position.
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
- /Hourly
Grade
RN2600
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.
