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Manager, Medicare and DSNP Utilization Management

Mass General Brigham (Enterprise Services)
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Apr 01, 2026
Responsible for overseeing clinical utilization management (UM) activities to ensure efficient use of resources for Medicare Advantage and DSNP members. Manages a team of clinical professionals, implements best practices, and collaborates with various departments to improve patient outcomes and streamline care processes. Essential Functions -Supervise and support a team of care coordinators and case managers, ensuring they adhere to clinical standards and protocols. -Develop and implement strategies to enhance the efficiency and effectiveness of clinical care coordination. -Monitor patient care processes and outcomes to ensure compliance with regulatory requirements and hospital policies. -Facilitate collaboration between clinical teams, physicians, and other healthcare providers to optimize patient care. -Review and analyze patient data to identify trends, areas for improvement, and opportunities for intervention. -Conduct regular performance evaluations and provide ongoing training and development for staff members. -Manage case load assignments and prioritize patient cases based on acuity and resource availability. -Oversee the implementation of new care models or technologies to improve patient care and operational efficiency. -Ensure accurate documentation and reporting of case management activities and patient care outcomes. Education Bachelor's Degree required Master's Degree Related Field of Study Licenses and Credentials Massachusetts Registered Nurse [RN] license required Experience At least 3-5 years of experience in clinical care coordination or case management required At least 2-3 years of experience in a supervisory or leadership role required At least 2-3 years of Medicare and DSNP UM experience required Knowledge, Skills, and Abilities Strong leadership and team management skills to effectively guide and support clinical staff. Excellent communication and interpersonal skills to collaborate with healthcare providers and patients. Analytical skills to assess patient care data and identify areas for improvement. Problem-solving abilities to address complex care coordination issues and implement effective solutions. Knowledge of regulatory requirements and industry best practices in clinical care and case management. Proficiency in healthcare management software and electronic health record systems. Working Conditions While a remote role, this team meets every quarter at the office at Assembly Row in Somerville and attendance is highly encouraged. 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.