RN Clinical Coordinator
- Employer
- University of Massachusetts Medical School
- Location
- 1 Technology Dr
View more categoriesView less categories
- Employment Type
- Full Time
- Institution Type
- Four-Year Institution
Job Details
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.
ResponsibilitiesMajor 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 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 consumer’s 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 driver’s 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
Supervision
Supervision received from Associate Director
Supervision Exercised
Supervision exercised over a team of clinicians
Environmental Working Conditions
Remote/desk work with- some statewide travel may be required
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Organization
Realize Your Opportunities – A Career at UMASS Medical School
Inside Workings at UMASS Medical School
The University of Massachusetts Medical School (UMMS), the Commonwealth's only public medical school, is proud of our role in serving the people of Massachusetts. Although, its the inside workings of UMMS that makes the difference.
Mission and Culture
- We’re serious about our mission and about our people.
- Real World Impact - Our people get excited about our mission of real-world impact in health sciences education, research and public service.
- International Prominence and New Opportunities - As this institution has grown to national – and international – prominence, we’ve found new opportunities to train tomorrow’s physicians, nurses and scientists, discover causes of and cures for disease and help improve the quality of health care.
- Deep Commitment - With our clinical partner, UMass Memorial Health Care, and our other teaching affiliates, we share a deep commitment to national distinction in patient care.
- Valued Partnerships – UMMS partners with Commonwealth Medicine, the health care consulting arm of UMMS. Also, UMMS partners with MassBiologics in scientific collaborations, technology management and creating partnerships for the development of products for the benefit of patients. These valued partnerships help us to provide services and programs to help meet our needs at UMMS and the public.
- Proud Contributors - People at UMMS enjoy the feeling of going to work every day knowing what they do is truly important and worthwhile.
- Complementary and Inseparable - These varied parts of our mission and culture are complementary and inseparable.
Careers
UMMS, the state’s first and only public academic health sciences center, educates physicians, scientists and advanced practice nurses to heal, discover, teach and care, with compassion. UMMS is a world-class institution with opportunities to match. 
Competitive Compensation – UMMS offers salaries that are competitive with Worcester-area employers. When combined with our generous benefits, perks, and paid time off, many job seekers are surprised to find a total rewards package that matches or exceeds their current situation.
Targeted Hiring Process – At UMMS, there are actually multiple hiring processes for different segments of our workforce. In nearly all cases, UMMS hiring process is decentralized, with qualified candidates screened and referred to an academic officer or manager with hiring authority.
24/7 Access to Employment Opportunities – iCIMS is our online job search and application system. iCIMS is available 24/7 to provide you with a convenient and up-to-date view of the available employment opportunities across our campuses. Updates are made daily and include all faculty and non-faculty position listings from every school and department within the UMMS. When you identify a position you are interested in and qualified for, apply online. New opportunities become available frequently so it pays to check back often!
Benefits
With outstanding benefits, competitive pay, extensive learning opportunities, and a stimulating and attractive work environment, UMMS may be exactly the employer you’ve been looking for.
• Superior Benefits - UMMS offers a wide range of benefits and perks that invite comparison with the best employers in the Worcester area – and with academic institutions anywhere. UMMS provides superior medical and dental coverage for you and your family, fully funded retirement plans, generous time off, a Tuition Assistance Plan – and much more.
• People Centered - UMMS is an employer, but it is also a community. Its comprehensive medical and dental benefits, retirement plans, and even paid holidays reflect an institution built around people, with a deep respect for their differences and needs.
• Commitment to Healthy Living - UMMS provides resources to help you balance work and life and encourages healthy living through great programs and discounts for fitness, physical activity, weight management, nutritional counseling and general wellness available through our health insurance plans.
• Breadth of Offerings - Above all, the breadth of UMMS offerings set the School apart and makes it an environment favored by all sorts of smart, career-savvy people.
Apply for a Job
As an equal opportunity and affirmative action employer, UMMS recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds.
Online - To view all job opportunities and apply online, visit www.umassmed.edu/hr and click on the “Careers” tab.
Start Now and Realize Your Opportunities!
A History of Making Vital Improvements - UMASS Medical School Milestones
1962: Legislation establishes University of Massachusetts Medical School
1970: First medical students begin classes in Shaw Building
1974: First class graduates 16 MDs
1979: PhD program begins
1986: Graduate School of Nursing opens
1986: PhD program becomes Graduate School of Biomedical Sciences
1994: Graduate School of Nursing initiates PhD program
1998: UMass Clinical System and Memorial Health Care merge to form UMass Memorial Health Care
2001: Lazare Research Building opens
2002: Campus Modernization begins on the University Campus
2004: Graduate Entry Pathway Program established at the Graduate School of Nursing
2005: PhD Program in Clinical & Population Health Research established at the Graduate School of Biomedical Sciences
2005: Massachusetts Biologic Laboratories opens new manufacturing and filling facility in Mattapan
2006: Craig Mello, PhD, Blais University Chair in Molecular Medicine and Howard Hughes Medical Institute Investigator, is awarded the Medical School's first Nobel Prize. Dr. Mello shared the 2006 Nobel Prize in Physiology or Medicine with Andrew Fire, PhD, of Stanford University, for their discoveries related to RNA interference.
2007: Michael F. Collins, MD, is named chancellor and Terence R. Flotte, MD, is named dean of the School of Medicine.
2009: Groundbreaking for the Albert Sherman Center, a 500,000-square-foot research and education facility slated for completion in 2012.
2010: Ambulatory Care Center opens
2012: The Albert Sherman Center, a 500,000-square-foot research and education facility, completed and opens
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