Clinical Coordinator

Job description

Overview 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. Responsibilities: Major 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 faci...