Mass General Brigham Health Plan
Six major aims for care
Mass General Brigham Health Plan believes that quality care should be:
- Safe: Care that is intended to help patients should not injure them.
- Effective: Services should be based on scientific knowledge and given to all who could benefit. Care should not be used when it will not be beneficial. Effective care should be precise: services should not be overused or underused.
- Patient-centered: Care should be respectful and responsive to individual patient preferences, needs, and values.
- Timely: Access to care should not take longer than necessary. Patients should not have to wait unless it will provide information or time to heal. Prompt attention benefits both the patient and the caregiver.
- Efficient: Effective care should minimize waste — and cost — of supplies, equipment, space, capital, ideas, time, and opportunities.
- Equitable: Everyone should have access to high quality care, regardless of their race, ethnicity, gender, or income.
Our mission and vision
Our vision is to help create a world in which all people live healthier lives. We strive to create a better health system by removing barriers, providing no-nonsense solutions, innovating through partnerships, and delivering compassionate experiences.About Mass General Brigham
From the hospital to home, our integrated health system offers high-quality care in every part of the health journey. For more information, please visit massgeneralbrigham.org.Search among Mass General Brigham Health Plan jobs
| Jobs: 1 - 10 of 11 |
Somerville, Massachusetts
Mass General Brigham Health Plan
The UMCM will utilize clinical knowledge to analyze, assess, and render approval decisions, to determine the need for physician review as well as complete determinations following physician review. The ideal candidate will have prior author...
11h
| Job Type | Full Time |
Customer Service Representative
Somerville, Massachusetts
Mass General Brigham Health Plan
The Opportunity The Customer Service Professional (CSP) acts as the primary point of contact for our members, providers and other key stakeholders focusing on exceptional customer satisfaction and first call resolution. The CSP's interact w...
1d
| Job Type | Full Time |
Utilization Management Care Manager
Somerville, Massachusetts
Mass General Brigham Health Plan
The UMCM will utilize clinical knowledge to analyze, assess, and render approval decisions, to determine the need for physician review as well as complete determinations following physician review. The ideal candidate will have prior author...
1d
| Job Type | Full Time |
Senior Medicare Compliance Program Manager
Somerville, Massachusetts
Mass General Brigham Health Plan
Responsible for leading and overseeing the development, implementation, and monitoring of the MGB Health Plan's Medicare compliance program. This role involves ensuring adherence to regulatory requirements, mitigating risks, and fostering a...
1d
| Job Type | Full Time |
Clinical Appeal and Grievance Nurse
Somerville, Massachusetts
Mass General Brigham Health Plan
The role is an integral part of our Appeals and Grievance review process and will ensure clinical/pharmacy appeal case reviews meet contractual, regulatory, and business goals. The position collaborates with members of the Appeal and Grieva...
5d
| Job Type | Full Time |
Behavioral Health Program Manager
Somerville, Massachusetts
Mass General Brigham Health Plan
The Behavioral Health (BH) Program Manager is responsible for the development and implementation of policies and procedures that measure the adherence of the health plan's BH clinical programs to CMS and/or Executive Office for Health and H...
5d
| Job Type | Full Time |
Somerville, Massachusetts
Mass General Brigham Health Plan
The Opportunity MGBHP is seeking an experienced EDI Developer who is responsible for the design, development and maintenance of EDI solutions for HIPAA EDI like 270/271, 276/277, 278, 820, 834, 835, 837 and 999 transactions. Must have a goo...
9d
| Job Type | Full Time |
Duals Supervisor, Appeals and Grievances
Somerville, Massachusetts
Mass General Brigham Health Plan
The Duals Supervisor, Appeals and Grievances provides day-to-day supervision of a team of 4-6 appeals and grievance coordinators and is ultimately responsible for the work product of this team and the Duals line of business. The Supervisor ...
10d
| Job Type | Full Time |
Manager, Appeals and Grievances
Somerville, Massachusetts
Mass General Brigham Health Plan
The role leads a team responsible for the processing of all Member Appeals and Grievances for Medicaid and Commercial product lines. Oversight includes appeal and grievance intake, investigation, and resolution. The position oversees all as...
19d
| Job Type | Full Time |
Epic Cogito & Analytics Developer
Somerville, Massachusetts
Mass General Brigham Health Plan
Under the direction of the Manager of Clinical Reporting and BI, Responsible for designing and implementing data analysis and reporting solutions to meet the data and reporting needs of the enterprise's clinical department. Work closely wit...
19d
| Job Type | Full Time |