Manager Utilization Review

Primary Responsibilities

• Manages team and related staff, including hiring, training, supervision, and performance management.
• Participates in policy and procedure review and development.
• Protects healthcare organization value by keeping information confidential, cautioning others regarding potential breaches.
• Maintains awareness of health insurance changes.
• Maintains compliance with regulation changes affecting utilization management.

• Bachelor's Degree Nursing
• Registered Nurse (RN) license
• 3+ years of Utilization Review experience
• 2+ years management experience

• Master's Degree Nursing
• Change management experience
• Integration experience
• Workday, UKG, Epic, NCG and/or Inter Qual experience
• Medical Necessity Appeals and Denials experience
• Peer to Peer experience

• 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.

• Remote
• Full‑time (40 hours) Monday through Friday, standard business hours with minimal weekend coverage
• Employees must use a stable, secure, and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB‑provided equipment.

Mass General Brigham Incorporated is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.