Resource Specialist I

Site: Mass General Brigham Incorporated

 

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.

 

The Opportunity
Reporting to Manager for Utilization Management, the Utilization Management Resource Specialist (UMRS) works collaboratively with the Utilization Management Case Managers (UMCM), Clinical Operations, Revenue Cycle Operations, and the Physicians Advisors providing direct administrative support to the utilization review processes and to the department. The UMRS must have strong communication skills and the ability to converse comfortably with internal and external customers. The position requires a high degree of flexibility, independence and willingness to participate in multiple activities and provide support to all members of the MGB team.

 

Job Summary

Primary Responsibilities
Work collaboratively with MGB Utilization Management to support an efficient, cost effective, and compliant utilization plan and care needs along the continuum. This may include, but is not limited to:
• Provides direct support to the utilization management case managers
• Provides reports to internal and external customers
• Conducts daily data collection per direction of UM leadership.
• Checks UR line for voicemails
• Faxes/emails communications to internal and external customers
• Manages email communication from payors by entering requests into the payor request folder, entering
requests into the peer to peer folder, forwarding payor emails to appropriate CM staff.
• Enters approved LOS from payors in EPIC
• Enters denials in the retro folder and documents the denial in auth cert.
• Works collaboratively with Admitting ensuring the patient has correct insurance entered and appropriate prior authorization.
• Manages all incoming faxes/emails
• Scans mail, memos, and other documents and enters approvals in EPIC
• Assists in escalating payor authorizations for patients going to rehab
• Updates payor dictionaries

 

What You'll Bring

Requirements:

• High School Diploma

Preferences:

• Associate's Degree
• 2+ years related experience (medical terminology, Electronic Medical Records (EMR), hospital utilization management or case management, prior authorization, etc.)

Additional Knowledge, Skills and Abilities:

- Familiarity with community services/resources.
- Ability to maintain effective working relationships with patients/families.
- Strong assessment and crisis intervention.
- Excellent interpersonal skills.
- Excellent collaboration, customer service and advocacy skills.
- Excellent written and verbal communication skills.

 

Schedule and Work Model

• Full-time (40 hours) Monday through Friday, standard business hours.
• Remote / Work from Home. 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.

 

Remote

 

399 Revolution Drive

 

40

 

Regular

 

Day (United States of America)

Pay Range

$19.42 - $27.74/Hourly

Grade

3
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.
Mass General Brigham Incorporated 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.

 

Mass General Brigham Competency Framework