Manager, Medicare Advantage Coordinated Care

Site: Mass General Brigham Health Plan Holding Company, Inc.

 

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.

 

 

Job Summary

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.

Responsible for providing leadership and oversight for care coordination and case management services within MGB Health Plan's Medicare Advantage line of business. This role ensures effective, patient-centered coordination of care across the continuum, supporting quality outcomes, safe transitions, and appropriate utilization of resources. The manager collaborates closely with interdisciplinary teams to improve care delivery and promote best practices in case management, discharge planning, and population health.

Essential Functions
-Oversee daily operations of care coordination and case management teams, including registered nurses, social workers, and support staff.
-Ensure timely and effective coordination of patient care plans, including discharge planning, transition of care, and resource referrals.
-Monitor workflows to support appropriate utilization review, medical necessity determinations, and regulatory compliance.
-Collaborate with clinical leadership, physicians, and external providers to resolve barriers to care and optimize patient flow.
-Develop and maintain policies, procedures, and workflows that align with industry standards, payer requirements, and internal goals.
-Manage performance metrics, including readmission rates, length of stay, denial rates, and patient satisfaction outcomes.
-Facilitate staff education, training, and professional development, support certification in case management and care transitions.
-Represent care coordination in interdisciplinary committees, quality improvement initiatives, and accreditation readiness efforts.
-Ensure compliance with CMS, Joint Commission, and other applicable regulations and standards.

 

Qualifications

Education

• Bachelor's Degree required
• Master's Degree preferred

Licenses and Credentials

• Massachusetts Registered Nurse (RN) required

Experience

• At least 5-7 years of experience in care coordination, case management, or discharge planning in a healthcare setting required
• At least 2-3 years of experience in a supervisory or leadership required
• At least 1-2 years of experience with utilization review, value-based care, population health, managed care principles, transitional care models, and interdisciplinary care planning preferred
• Experience working for a health plan supporting its Medicare Advantage line of business highly preferred
• Experience preparing for CMS audits highly preferred
   

Knowledge, Skills, and Abilities

• In-depth knowledge of case management standards, patient care coordination strategies, and healthcare regulations.
• Strong leadership, team-building, and staff development skills.
• Excellent communication, problem-solving, and negotiation abilities.
• Ability to analyze data, identify trends, and implement process improvements.
• Proficiency in electronic health records (EHRs), case management systems, and reporting tools.

 

Additional Job Details (if applicable)

Working Conditions

• This is a hybrid role with occassional office visits (a few times/quarter)

 

Remote Type

Hybrid

 

Work Location