Utilization Management Transitions of Care Coordinator
Mass General Brigham Health Plan, Somerville, MA, United States
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 with one of the world’s leading integrated healthcare systems, providing members with innovative, member‑centered solutions 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. We work with accomplished professionals in healthcare, offering learning and contribution opportunities in a supportive, inclusive environment that embraces diverse backgrounds, experiences, and skills. We provide competitive salaries, a benefits package, flexible work options, career growth, and more.
The role is an integral part of our clinical coordination team, supporting providers, facilities, and members to ensure a streamlined transition process between care levels. I serve as the single point of contact for facilities and providers when a member requires special support, a difficult transition plan is underway, or barriers to obtaining the next level of care arise. I track long‑stay members to move them to the next appropriate level of care and collaborate with Utilization Management, Appeal and Grievance, Care Management, and medical director teams to resolve transitional needs.
Essential Functions
In conjunction with other team members, I ensure that transitional needs and barriers are resolved in a timely manner to meet regulatory timeframes.
I directly interact with providers and their staff to obtain additional clinical information, and with members or their advocates to understand the full need to transition a member from one level of care to another.
I review information and provide recommendations to the collaborative team based on analysis of the clinical material.
I track and monitor the status of long‑stay inpatient/post‑acute cases, ensuring timely discharge planning.
I identify trends and patterns in discharge barriers with facilities and providers.
I coordinate communication between patients, healthcare providers, and insurance companies regarding discharge needs.
I coordinate communication with state and federal partners to ensure length of stay reporting is timely and accurate, delivering follow‑up information as requested by line of business or regulatory partners.
I participate in interdisciplinary meetings to discuss complex cases and recommend solutions.
Education
Associate’s Degree Nursing required or Bachelor’s Degree in Healthcare Administration required or Bachelor’s Degree in 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.
Proficiency 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.
Working Conditions
This is a remote role that can be done from most U.S. states.
Mass General Brigham Health Plan Holding Company, Inc. 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.
#J-18808-Ljbffr
The role is an integral part of our clinical coordination team, supporting providers, facilities, and members to ensure a streamlined transition process between care levels. I serve as the single point of contact for facilities and providers when a member requires special support, a difficult transition plan is underway, or barriers to obtaining the next level of care arise. I track long‑stay members to move them to the next appropriate level of care and collaborate with Utilization Management, Appeal and Grievance, Care Management, and medical director teams to resolve transitional needs.
Essential Functions
In conjunction with other team members, I ensure that transitional needs and barriers are resolved in a timely manner to meet regulatory timeframes.
I directly interact with providers and their staff to obtain additional clinical information, and with members or their advocates to understand the full need to transition a member from one level of care to another.
I review information and provide recommendations to the collaborative team based on analysis of the clinical material.
I track and monitor the status of long‑stay inpatient/post‑acute cases, ensuring timely discharge planning.
I identify trends and patterns in discharge barriers with facilities and providers.
I coordinate communication between patients, healthcare providers, and insurance companies regarding discharge needs.
I coordinate communication with state and federal partners to ensure length of stay reporting is timely and accurate, delivering follow‑up information as requested by line of business or regulatory partners.
I participate in interdisciplinary meetings to discuss complex cases and recommend solutions.
Education
Associate’s Degree Nursing required or Bachelor’s Degree in Healthcare Administration required or Bachelor’s Degree in 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.
Proficiency 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.
Working Conditions
This is a remote role that can be done from most U.S. states.
Mass General Brigham Health Plan Holding Company, Inc. 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.
#J-18808-Ljbffr