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 13 |
Clinical Quality Program Manager
Somerville, Massachusetts
Mass General Brigham Health Plan
Responsible for overseeing and improving clinical performance metrics and ensuring compliance with healthcare regulations and accreditation standards. Collaborates with clinical teams to develop strategies for improving patient care outcome...
23h
| 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 ...
23h
| Job Type | Full Time |
Medicare DSNP Redetermination Coordinator
Somerville, Massachusetts
Mass General Brigham Health Plan
Responsible for outreaching to members to assist them with the Medicaid Enrollment Redetermination process. This position is responsible for monitoring and optimizing processes related to Enrollment Redetermination. Essential Functions -Mon...
1d
| Job Type | Full Time |
Medicare Supervisor Claims Reviewer
Somerville, Massachusetts
Mass General Brigham Health Plan
Responsible for overseeing a team of 4-5 employees that assesses Medicare claims for accuracy, compliance, and eligibility, ensuring that claims are processed efficiently and in accordance with industry standards, regulatory requirements, a...
4d
| Job Type | Full Time |
Somerville, Massachusetts
Mass General Brigham Health Plan
Responsible for evaluating and analyzing group insurance experience and community-rated fully and self-insured accounts. This role involves assessing the financial and operational aspects of group insurance proposals to determine coverage e...
8d
| 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...
9d
| 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...
9d
| 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...
18d
| Job Type | Full Time |
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...
18d
| 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...
19d
| Job Type | Full Time |