RN Clinical Coordinator - Care Coordination Lead (Remote)

University of Massachusetts Medical School; Westborough (MA); Remote; USD 85,000 - 110,000; Full time

Job summary

University of Massachusetts Medical School seeks a Clinical Coordinator to develop, prioritize, and oversee staff activities coordinating care for MassHealth members with complex needs. You will supervise clinical review activities and implement improvements in clinical processes.

You will provide clinical direction, collaborate with state agencies, and design training for staff and providers. The role requires leadership, regulatory interpretation, and ability to travel statewide.

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 team’s 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 consumer’s residence, as necessary.
• Collaborate with other Executive Office of Health and Human Services’ Agencies regarding 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.

Skills

Regulatory interpretation

Leadership

Communication

Education

BA/BS in a 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 develop, prioritize, and oversee staff activities coordinating care for MassHealth members with complex needs. You will supervise clinical review activities and implement improvements in clinical processes.

You will provide clinical direction, collaborate with state agencies, and design training for staff and providers. The role requires leadership, regulatory interpretation, and ability to travel statewide.