At Mass General Brigham, are developing the integrated healthcare system of the future. The largest healthcare system in the state of Massachusetts, MGB has 2 academic hospitals, 3 specialty hospitals, 7 community hospitals, a health insurance provider (MGB Health Plan) and Home Care division. We recognize that increasing value and continually improving quality while maintaining an inclusive focus are essential to organizational excellence, and we invite you to join us on this journey.

The Executive Director, Utilization Management for MGB Care Continuum is a key member of the MGB Care Continuum leadership team reporting to the Vice President, MGB Care Continuum. The Leader is responsible for the further development and overall execution of a comprehensive MGB-wide utilization management strategy, including oversight of MGB wide care continuum utilization management leaders. This experienced leader will be responsible for planning, shaping, directing, and ensuring the success of all teams and initiatives related to utilization management for the system in collaboration with MGB revenue cycle.

Responsibilities:

The Executive Director role will execute on the MGB Care Continuum utilization management strategy, including, but not limited to:

• Setting MGB-wide Care Continuum utilization management strategy and priorities and directing an updated utilization management leadership and governance structure in collaboration with MGB revenue cycle leadership
• Designing, launching, and overseeing MGB utilization management leadership structure with direct reporting oversight of local UM leaders across the system. Balancing alignment to a system-wide UM strategy while maintaining UM presence and relationships at their local organization
• Demonstrating ownership & accountability of enterprise-wide utilization management outcomes
• Optimizing and aligning (as appropriate) utilization management across MGB institutions and balancing local versus central structures, processes, policies, education, physician advisors, and technology
• Build and maintain collaborative relationships with key MGB leaders, including but not limited to, finance, revenue cycle operations, case management, contracting, patient access, physician advisors, and compliance.
• Collaborating with leaders at Academic Medical Centers and Community Hospitals to meet enterprise UM goals while maintaining a commitment to individual organization nuances.
• Ensuring alignment between case management and utilization management at both the front-line and leadership level, centrally and locally.
• Building trusting relationships external to the MGB enterprise, including payors, professional organizations and state agencies

To support these efforts and beyond, the MGB Leader of Utilization Management requires expertise and experience in utilization management, strong business acumen, clinical expertise, and effective collaboration with health system and hospital leaders and staff, payors, and government agencies.

Principal Duties and Responsibilities

The Leader of Utilization Management will:

• Design, implement and lead a central Care Continuum utilization management leadership and governance structure that directly oversees UM leaders across the enterprise to facilitate enterprise best practices in utilization management.
• Build and manage an organizational structure composed of direct and matrixed team
• Execute, deliver, and drive, directly and indirectly, prioritized strategies and initiatives related to Care Continuum utilization management
• Develop, monitor and maintain key performance indicators and develop recommendations, identify trends & opportunities for performance improvement
• Cultivate yourself and serve as an enterprise-wide and industry expert in processes, policies and technology that support best practice utilization management
• Create and maintain key relationships at MGB organizations, including case management and utilization management front-line staff, leaders and physician advisors.
• Create and maintain key relationships external to MGB as it relates to care continuum utilization management, including commercial and government payor leaders and representatives.
• Provide support and problem solve with other case management leaders on patients with extensive length of stays
• Promote diversity and inclusion
• Partner with educational leaders to develop comprehensive educational and training programs around utilization management for multiple disciplines
• Conduct ongoing observation and assessment of utilization management processes and outcomes across the enterprise to ensure compliance with standards of practice, policies and procedures to assess opportunities for improvement.
• Develop and maintain enterprise-wide policies & procedures and training & orientation manuals
• Participates in hiring, evaluations, discipline, corrective action plans and workplace investigations, as needed
• Participates in development of programs/systems to meet the requirements of state and federal regulatory agencies to ensure compliance.
• Perform other duties and special projects as assigned

• 8-10 years working in a leadership role with recent experience in utilization management.
• Bachelor's degree health care administration, or related field. A clinical degree (RN, LICSW, etc.) strongly preferred
• Bachelor's degree, required. Master's or professional degree in healthcare or related field, preferred. Clinical degree strongly preferred.
• Extensive experience and resource knowledge regarding case management overall and utilization review specifically
• An understanding of healthcare economics and regulatory and payor compliance in the acute care, ambulatory, post-acute settings

Skills:

* Leadership. Fosters a shared vision and strategy to drive high performance in support of departmental and organizational goals.

* Quality. Creates high-quality work products appropriate for audiences consisting of MGB and hospital-based senior leadership and/or external clients. Demonstrates exceptional organizational skills and attention to detail.

* Finance. Is highly skilled in budgeting, financial modeling, and internal financial processes

* Integrity. Demonstrates reliability and impeccable integrity, with focus on accomplishment of departmental and institutional goals in alignment with our mission.

* Diplomacy. Ability to manage and navigate sensitive inter-departmental and inter-organizational politics.

* Problem-Solving. Demonstrates exceptional critical thinking and problem-solving skills, in both a technical and interpersonal capacity.

* Communication. Possesses excellent written and verbal communication skills. Demonstrates an ability to communicate and present work appropriately to diverse audiences.

* Judgment. Demonstrates sound judgment and decision-making capabilities; knows when and to whom to escalate problems as needed.

* People Management. Recruits and inspires high performing team. Serves as an adept supervisor and coach to various direct and indirect reports; strong team-builder with ability to provide support, direction and development to staff.

* Project Management. Demonstrates strong organization and prioritization skills in the simultaneous management of multiple large, complex, and long-term projects.

* Analytical. Demonstrates highest level skills in conceptualizing and conducting complex analyses and modeling; communicates results of analyses to non-technical audiences clearly and effectively.

* Technical. Proficient in the Microsoft Office Suite, including Excel, Word, PowerPoint, Visio, etc.

* Proven track record managing and leading teams (including coaching and mentoring) in a direct and matrixed environment to meet not only current needs but future needs.

* Experience leading a successful enterprise program and project portfolio and team.

* Ability to influence, organize, and lead people across organizational levels and functions.

* Skill in organizing and prioritizing work, taking initiative, effectively managing multiple projects, delegating, and achieving goals and objectives.

Supervisory Skills:

• Will provide direct management for 3-5 leaders with the overall direct and indirect management to be 25-30 FTEs within the next 3 years
• Responsible for managing enterprise resources appropriately and leading the effort to manage and oversee MGB wide Utilization Management financial outcomes as it relates to the care continuum service line.
• Fiscal Responsibilities:
• Responsible for managing enterprise resources appropriately and leading the effort to manage and oversee MGB wide Utilization Management financial outcomes as it relates to the care continuum service line.
• Conditions:

• This position is a remote/hybrid working model with approx. 2 days on site each week. In addition, it may require occasional local travel to MGB sites, vendors, and/or conference.

• Out of State candidates would be required to relocate unless living in a neighboring state and the ability to commute to Boston twice a week.

Mass General Brigham is an Equal Opportunity Employer & by embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law.