Clinical Coordinator

University of Massachusetts Medical School; Shrewsbury (MA); On-site; USD 70,000 - 90,000; Full time

Job summary

A leading medical institution in Shrewsbury is seeking a Clinical Coordinator responsible for overseeing care coordination for MassHealth members. The ideal candidate has extensive experience in clinical management, a BS in a related field or RN license, and strong leadership skills. This full-time position offers an opportunity to drive clinical excellence and improve service quality for patients with complex health needs.

Qualifications

• 5-10 years of related work experience with management experience in a clinical coordination role.
• Ability to interpret regulations and work independently.

Responsibilities

• Provide clinical direction and supervision to clinical review teams.
• Research and interpret MassHealth regulations for providers.
• Participate in site visits to assess provider compliance.

Skills

Leadership

Clinical direction

Analytical skills

Education

BA/BS in related field or equivalent experience

RN licensed to practice in Massachusetts

Tools

Word

Excel

Job description

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Clinical Coordinator Job Number: 2025-48588
Category: Administrative Professional
Location: Shrewsbury, MA
Shift: Day
Exempt/Non-Exempt: Exempt
Business Unit: ForHealth Consulting
Department: ForHealth Consulting - Community Service - W401950
Job Type: Full-Time
Salary Grade: 46
Num. Openings: 1
Post Date: Aug. 25, 2025

Job Summary

Under the general direction of the Associate Director, or designee, the Clinical Coordinator is responsible to develop, prioritize, and oversee staff activities specifically designed to promote the coordination of care for those MassHealth members who have medically complex, chronic or catastrophic illnesses that require a customized approach to how, when, and where they receive medically necessary health care services. This position provides leadership for the ongoing development of clinical competence and practice. In collaboration with colleagues, this position will supervise and implement improvements to clinical review activities.

Major Responsibilities

• Provide clinical direction, supervision, and support to the clinical review teams determination of eligibility and/or authorize services for members in accordance with program guidelines and regulations.
• Supervise and perform the approval, modification or denial of requested services consistent with established procedural standards and MassHealth program rules and regulations to monitor provider compliance.
• Participate in on-site visits to MassHealth providers, long-term care facilities, rehab facility, acute care facility and/or consumers residence, as necessary.
• Collaborate with other Executive Office of Health and Human Services Agencies regarding the issues of various MassHealth populations.
• Research MassHealth regulations and interpret these regulations for providers and clinical review team
• Provide clinical support to MassHealth program managers, and design and present training sessions for in-house staff or MassHealth providers as necessary.
• Review and propose changes to applicable MassHealth program regulations, policies, and other documents.
• Coordinate contacts with MassHealth providers to respond to inquiries pertaining to specific program areas.
• Prepare and respond to inquiries related to appeals following clinical determinations
• Foster team environment, and provide professional and clinical leadership to team members, including consultants, providers and administrative support staff as appropriate.
• Direct team members in identifying and addressing issues involving clinical matters.
• Interface with state agencies and providers regarding clinical determination of medical necessity and program compliance.
• Communicate policy, workflow and organizational changes to team members.
• Provide orientation and ongoing in-service/continuing education programs for team members.
• Conduct performance evaluations of team members.
• Participate in the hiring and termination of team members.
• Work closely with Director and other management staff to ensure clinical integrity is maintained in the clinical eligibility and nurse reviewer processes.
• Maintain confidentiality of all business documents and correspondence.
• In collaboration with the Director and other management staff to coordinate performance improvement and quality assurance activities.
• Attend and participate in meetings as required.
• Prepare written reports/determinations as requested.
• Travel to and from providers places of business, state agency offices, long-term care or rehab facilities, acute care facilities and/or consumers residence.
• Perform other related duties as required or assigned.

Required Qualifications

• BA/BS in a related field or equivalent experience required
• OR
• RN licensed to practice in Massachusetts
• AND
• 5-10 years of related work experience with at least 2 years supervisory or management experience in a clinical care coordination role
• Ability to interpret appropriate regulations
• Ability to work independently and collaboratively
• Experience with Word and Excel and other desktop tools
• Ability to travel statewide to member/applicant/participant homes and service providers places of business
• Valid drivers license required

Preferred Qualifications

• 3 years of related work experience with prior authorization and/or eligibility determinations for disabled, medically complex, home care, rehab or long term care populations strongly preferred
• Knowledge of MassHealth Hearing and Appeals process preferred
• Knowledge of MassHealth regulations preferred
• Strong analytical and problem solving skills preferred
• Professional certifications are preferred

UMass Chan Medical School was among 23 companies that stood out as 2023 “DEI champions,” according toThe Boston Globe.

Named a U.S. News & World Report
“2023 BEST MEDICAL GRAD SCHOOL”
for Primary Care and Research