<p>Site: Mass General Brigham Health Plan Holding Company, Inc.</p> <p>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.</p> <p>Job Summary</p> <p>The D-SNP UM Case Manager, RN performs utilization management activities primarily for D-SNP (OneCare and Senior Care Options), including review of integrated organization determinations for outpatient, inpatient, post-acute, and long-term services and supports (LTSS) following CMS and EOHHS regulations.</p> <p>Qualifications</p> <p>Education</p> <ul> <li>Associate's Degree Nursing required; Bachelor's Degree Nursing preferred </li></ul> <p>Licenses and Credentials</p> <ul> <li>Massachusetts Registered Nurse license required </li><li>Basic Life Support [BLS Certification] Certification preferred </li></ul> <p>Experience</p> <ul> <li>At least 2-3 years of utilization management strongly preferred </li><li>Experience applying National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and LTSS guidelines highly preferred </li><li>InterQual experience preferred </li></ul> <p>Knowledge, Skills, and Abilities</p> <ul> <li>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. </li><li>Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems. </li><li>Ability to establish strong rapport and relationships with patients and staff. </li><li>Proficient in Microsoft Office and industry related software programs. </li><li>Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions. </li><li>Ability to maintain client and staff confidentiality. </li><li>Understanding of diagnostic criteria for dual conditions and the ability to conceptualize modalities and placement criteria within the continuum of care. </li><li>Knowledge of Healthcare and Managed Care preferred. </li></ul> <p>Additional Job Details (if applicable)</p> <p>Working Conditions</p> <ul> <li>This is a remote role that can be done from most US states </li></ul> <p>Remote Type</p> <p>Remote</p> <p>Work Location</p> <p>399 Revolution Drive</p> <p>Scheduled Weekly Hours</p> <p>40</p> <p>Employee Type</p> <p>Regular</p> <p>Work Shift</p> <p>Day (United States of America)</p> <p>Pay Range</p> <p>$58,656.00 - $142,448.80/Annual</p> <p>Grade</p> <p>98TEMP</p> <p>At Mass General Brigham, we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive, and any offer extended will take into account your skills, relevant experience if applicable, education, certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however, it does not encompass all elements contributing to your total compensation package. In addition to competitive base pay, we offer comprehensive benefits, career advancement opportunities, differentials, premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply, and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.</p> <p>EEO Statement:</p> <p>Mass General Brigham Health Plan Holding Company, Inc. 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 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. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran's Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.</p> <p>Mass General Brigham Competency Framework</p> <p>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.</p>