Remote RN Clinical Coordinator — Care Coordination Lead

University of Massachusetts Medical School; Oregon; Hybrid; USD 85,000 - 110,000; Full time

Job summary

University of Massachusetts Medical School seeks a Clinical Coordinator to lead a clinical review team and coordinate care for MassHealth members with complex needs. You will supervise staff, ensure compliance with program rules, and oversee ongoing clinical review improvements across facilities and residences.

Responsibilities include directing eligibility reviews, approving or denying services, training staff, and collaborating with MassHealth and other agencies while maintaining strict

Qualifications

• BA/BS in a related field or equivalent experience; RN license in MA is acceptable.
• 5-10 years of related work experience with at least 2 years supervisory or management experience.
• Ability to interpret MassHealth regulations and apply them to clinical reviews.
• Travel statewide to member homes and provider sites; valid driver’s license required.

Responsibilities

• Provide clinical direction, supervision, and support to the clinical review team’s determinations.
• Approve, modify or deny services per program rules and MassHealth regulations.
• Collaborate with state agencies and providers; conduct training sessions as needed.
• Interface with multiple facilities and consumer residences; maintain confidentiality.

Skills

Supervisory experience

Independent and collaborative work

Regulatory interpretation

Travel statewide

Analytical thinking

Education

BA/BS in related field or equivalent experience

RN licensed to practice in Massachusetts

Tools

Word

Excel

Job description

University of Massachusetts Medical School seeks a Clinical Coordinator to lead a clinical review team and coordinate care for MassHealth members with complex needs. You will supervise staff, ensure compliance with program rules, and oversee ongoing clinical review improvements across facilities and residences.

Responsibilities include directing eligibility reviews, approving or denying services, training staff, and collaborating with MassHealth and other agencies while maintaining strict