Medicare Utilization Management Supervisor

Mass General Brigham Health Plan
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Apr 09, 2026
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 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 supervisor will work closely with the Manager of Clinical, to oversee the daily operations of roughly 5 Medicare Advantage utilization management staff. The supervisor will be responsible for the direct coaching, supervision, and evaluation of licensed clinical staff. The supervisor may be required to participate in projects across the organization to support new products or address business needs Essential Functions -Expertise in clinical inpatient and outpatient utilization management reviews utilizing InterQual, company policies and procedures, and other resources as determined by review, including physician reviews as needed. -Educate staff on quality review requirements and documentation guidelines, with emphasis on highly accurate and specific documentation consistent with national regulations and practice. -Monitor individual productivity and adjust assignments as needed to support productivity goals, ensure quality reviews, maintain timeliness, and achieve an equitable distribution of cases. -Report staff productivity trends and any other department/staff concerns to the manager as needed. -Ensure site assignments, phone/fax lists, hospital reports, etc., are updated and accurate. -Monthly review of staff roles, metrics, and quality of work, making readjustments to align with MedAdv regulations and Mass General Brigham Health Plan goals as needed. -Develop tools and workflows to ensure accuracy and completeness of reviews and documentation. Education Bachelor's Degree Related Field of Study required (experience can be considered in lieu of a degree) Licenses and Credentials Massachusetts Registered Nurse (RN) license Certified Case Manager [CCM] preferred Experience At least 3-5 years of relevant experience in managed care setting with knowledge of utilization management required Expertise in clinical inpatient and outpatient care required Leadership and/or supervisory experience preferred Knowledge, Skills, and Abilities Proficient user with Microsoft Office and McKesson InterQual. Excellent verbal, written, listening, and interpersonal skills. Demonstrate Mass General Brigham Health Plans' core brand principles of always listening, challenging conventions, and providing value. Working Conditions 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.