Remote RN Clinical Coordinator: Care Coordination Lead

ForHealth Consulting at UMass Chan Medical School

Westborough (MA)

On-site

USD 70,000 - 90,000

Full time

14 days+

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Job summary

The University of Massachusetts Chan Medical School is seeking a Clinical Coordinator to develop, prioritize, and oversee staff activities designed to promote care coordination for MassHealth members with complex needs.

In this role you will lead clinical review activities, supervise staff, and collaborate with colleagues to implement improvements in clinical review processes, ensuring alignment with program guidelines and regulations across various healthcare settings.

Qualifications

BA/BS in a related field or equivalent experience required OR RN licensed to practice in Massachusetts.
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 driver's license required.

Responsibilities

Provide clinical direction, supervision, and support to the clinical review teams determination of eligibility and/or authorize services for members.
Supervise and approve or deny services consistent with program rules to monitor provider compliance.
Participate in on-site visits to MassHealth providers and facilities as needed.
Collaborate with state agencies regarding MassHealth populations.
Research MassHealth regulations and interpret for providers and staff.
Design and present training sessions for staff or providers.
Review and propose changes to MassHealth regulations, policies, and documents.
Coordinate contacts with MassHealth providers to respond to inquiries.
Prepare and respond to inquiries related to appeals following determinations.
Foster team environment and provide leadership to team members.
Direct team members in addressing clinical issues and ensure compliance.
Interface with state agencies and providers regarding medical necessity.
Communicate policy and workflow changes to team members.
Provide orientation and ongoing education programs for staff.
Conduct performance evaluations and participate in hiring.