New

Resource Specialist I

Mass General Brigham (Enterprise Services)
remote work
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
Dec 02, 2025
Primary Responsibilities Work collaboratively with MGB Utilization Management to support an efficient, cost effective, and compliant utilization plan and care needs along the continuum. This may include, but is not limited to: * Provides direct support to the utilization management case managers * Provides reports to internal and external customers * Conducts daily data collection per direction of UM leadership. * Checks UR line for voicemails * Faxes/emails communications to internal and external customers * Manages email communication from payors by entering requests into the payor request folder, entering requests into the peer to peer folder, forwarding payor emails to appropriate CM staff. * Enters approved LOS from payors in EPIC * Enters denials in the retro folder and documents the denial in auth cert. * Works collaboratively with Admitting ensuring the patient has correct insurance entered and appropriate prior authorization. * Manages all incoming faxes/emails * Scans mail, memos, and other documents and enters approvals in EPIC * Assists in escalating payor authorizations for patients going to rehab * Updates payor dictionaries What You'll Bring Requirements: High School Diploma Preferences: Associate's Degree 2+ years related experience (medical terminology, Electronic Medical Records (EMR), hospital utilization management or case management, prior authorization, etc.) Additional Knowledge, Skills and Abilities: - Familiarity with community services/resources. - Ability to maintain effective working relationships with patients/families. - Strong assessment and crisis intervention. - Excellent interpersonal skills. - Excellent collaboration, customer service and advocacy skills. - Excellent written and verbal communication skills. Schedule and Work Model Full-time (40 hours) Monday through Friday, standard business hours. Remote / Work from Home. Employees must use a stable, secure, and compliant workstation in a quiet environment. Teams video is required and must be accessed using MGB-provided equipment. Mass General Brigham Incorporated 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. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.