While a remote role, this team meets every quarter at the office at Assembly Row in Somerville and attendance is highly encouraged. This role would also require on-call coverage on the weekends/holidays (currently every other weekend). The ideal candidate for this role will have Medicare Advantage appeals experience. Part of this role is building cases, gathering information to support an appeal, and making cases from beginning to end. The ideal ...
Responsible for engaging prospective and existing customers through inbound and outbound communications, identifying their insurance needs, and recommending tailored solutions that align with our product offerings. Essential Functions. Conduct outbound and receive inbound calls to offer MGB Health plan products. Deliver compelling sales presentations and proposals that effectively communicate the MGBH DSNP plan offerings. Meet or exceed monthly a...
The Opportunity. Mass General Brigham is hiring two Transitions of Care Coordinators to work as part of an interdisciplinary care team dedicated to supporting enrollees and their families in navigating the healthcare system through effective planning and coordination of care transitions. This role will primarily serve enrollees in the One Care and Senior Care Options (SCO) programs. The Transitions of Care Coordinator is a Registered Nurse who ac...
Responsible for managing all aspects of a duals product portfolio. Leads and implements initiatives that support alignment with organizational goals and strategic planning. Oversees communication and collaboration with internal and external stakeholders. Develops the program calendar, acts as key liaison to the organization, and supports various program activities. Analyzes key elements of the dual program and is responsible for providing updates...
The Opportunity. The Payment Policy Manager is vital to the team and responsible for developing, implementing, and managing payment policies and strategies by analyzing regulatory changes and reimbursement models to optimize revenue and ensure compliance with federal, state, and payer-specific guidelines. This role works closely with clinical, financial, and revenue cycle teams to interpret payment policies and provide guidance on reimbursement p...
The Opportunity. Mass General Brigham Health Plan is hiring two RNs: Assessment Registered Nurse (RN) to perform initial and ongoing face-to-face, virtual, or telephonic comprehensive assessments and evaluations. The Assessment RN is responsible for ensuring the accuracy and quality of all assessments, as well as the timely submission of documentation to MassHealth. The Assessment RN completes timely, accurate, and high-quality assessments. They ...
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 experi...
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 experi...
The Opportunity. Mass General Brigham Health Plan is hiring for two Behavioral Health Specialists to work as part of an interdisciplinary care team providing expert recommendations for managing behavioral health conditions and providing specialized coordination of care for enrollees with Severe Mental Illness (SMI) and Substance Use Disorders (SUD). As the behavioral health clinical expert on the Interdisciplinary Care Team, the Behavioral Health...
The Claims Operations Manager is responsible for managing commercial claims operations to ensure efficient and accurate processing of claims. Oversees claims workflows, compliance, and team performance to support revenue cycle goals and optimize reimbursement processes. The ideal candidate will possess excellent communication and organizational ability. They will have a strong aptitude for technology and its impact on claims operations. Responsib...
The Opportunity. The Sr Business Intelligence Developer is vital to the team. You will use Microsoft Business Intelligence tools, primarily Microsoft SSMS, SSAS, and SSIS to maintain BI data structures in support of operational, clinical, and financial analysis. Support Data Scientists on the team with Microsoft SQL queries, ETL processes and Python. What You'll Do. Supports BI Development and works with the data scientists to support and learn w...
The Opportunity. The Sr Business Intelligence Developer is vital to the team. You will use Microsoft Business Intelligence tools, primarily Microsoft SSMS, SSAS, and SSIS to maintain BI data structures in support of operational, clinical, and financial analysis. Support Data Scientists on the team with Microsoft SQL queries, ETL processes and Python. What You'll Do. Supports BI Development and works with the data scientists to support and learn w...
