Utilization Management Supervisor, Medicare and Duals

Medicare and Duals (One Care and SCO) Supervisor

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs 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. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a welcoming and supportive environment that embraces their unique and varied backgrounds, experiences, and skills. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.

The Medicare and Duals (One Care and SCO) Supervisor will work closely with the Utilization Manager of Duals / Medicare Advantage to oversee the daily operations of the Utilization Management (UM) Staff. The incumbent will be responsible for the direct coaching, supervision, and evaluation of licensed clinical and non-clinical staff in various roles. The incumbent will be required to participate in various meetings and agile groups for the business needs. The Duals / Medicare Advantage reports to the clinical manager in the Utilization Management Department for Duals / Medicare Advantage. This supervisor may be responsible for supporting other supervisors within the department and coverage of delegated work from the clinical manager.

Principal Duties and Responsibilities :

• Provide leadership and daily oversight of utilization management functions for Medicare Advantage and One Care / SCO Dual populations.
• Oversee a team of clinicians as well as non-clinical support staff.
• Ensure compliance with CMS, Medicare, and state duals program regulatory requirements, including NCD's, LCD's and MassHealth guidelines.
• Supervise clinical reviews for inpatient, outpatient, and community-based services, utilizing InterQual, company policies and / or physician reviews as appropriate.
• Monitor team performance, provide coaching and mentorship to foster a culture of accountability, collaboration, and continuous improvement.
• Partner with internal and external stakeholders to ensure timely, member-centered, and regulatory-compliant service delivery.
• Organize and facilitate team meetings; track and report on utilization trends, productivity, and quality outcomes.
• Leverage technology (Microsoft Office, McKesson InterQual, Sharepoint, web-based systems) to manage workflows, reporting, and communication.
• Demonstrate strong project management and problem-solving skills, with the ability to prioritize competing demands and support departmental initiatives.
• Promote professional growth and development within the team while maintaining a strong customer focus and commitment to member satisfaction.

Qualifications :

Working Conditions :

The pay range for this position is $78,000.00 - $113,453.60 / Annual.

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.