Utilization Management Care Manager
Company: Partners Healthcare System
Posted on: June 6, 2021
Summary of Position
A career at AllWays Health Partners is you in every way!
Inspired by our affiliation with Partners HealthCare, our promise
as a people-first organization starts with our employees. Get
inspired to bring your unique talents to our diverse community and
challenge the health care industry status quo with innovative
programs that put people first. Our perks include a competitive
benefits package, access to world-class doctors, and more.
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 authorization requests for medical services, including
making initial eligibility and coverage determinations, screening
for medical necessity appropriateness, determining if additional
information is required, and referral to correct programs within
AllWays Health Partners as needed.
- Manage incoming requests for procedures and services including
patient medical records and related clinical information.
- Adherence to program, departmental and organizational
performance metrics including productivity.
- Excellent communication skills both verbal and written;
excellent problem solving and customer service skills are
- Must be self directed and highly motivated with an ability to
- Develop and maintain effective working relationships with
internal and external customers
- Hold self and others accountable to meet commitments.
- Ensure diversity, equity, and inclusion are integrated as a
- Persist in accomplishing objectives to consistently achieve
results despite any obstacles and setbacks that arise.
- Build strong relationships and infrastructures that designate
AllWays Health Partners as a people-first organization.
Department Specific Functions
- Experience with clinical applications/systems.
- Proficiency in PC operating system, MS Office applications
- Other duties as assigned with or without accommodation.
Working Conditions and Physical Effort
- Work is normally performed in a typical office work
Knowledge and Education
- Registered Nurse (RN) with current state license, plus BSN or
- UM Certification (InterQual)
- 1-2 years experience in a payer setting
- Experience using InterQual/Milliman
- Demonstrate AllWays Health Partners' core brand principles of
always listening, challenging conventions, and providing
- Strong aptitude for technology-based solutions.
- Ability to inject energy, when and where it's needed.
- Respect the talent and unique contribution of every individual,
and treat all people in a fair and equitable manner.
- Exercise self-awareness; monitor impact on others; be receptive
to and seek out feedback; use self-discipline to adjust to
- Be accountable for delivering high-quality work. Act with a
clear sense of ownership.
- Bring fresh ideas forward by actively listening to and working
with employees and the people we serve.
The UM CM reports directly to the assigned UM department
Keywords: Partners Healthcare System, Somerville , Utilization Management Care Manager, Other , Somerville, Massachusetts
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