University of Massachusetts Medical School

  • Allied Health Clinical Coord

    Minimum Salary US-MA-Shrewsbury
    Job Location 1 week ago(1 week ago)
    Requisition Number
    2018-31617
    # of Openings
    1
    Posted Date
    Day
    Shift
    Exempt
  • Overview

    GENERAL SUMMARY OF POSITION:

    Under the general direction of the Associate Director or designee the Clinical Manager (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 allied health clinical reviewer team’s evaluation of the Medicaid provider’s prior authorization requests for services and/or equipment.
    • Supervise and/or participate in the approval, modification or denial of provider-requested services consistent with established procedural standards and MassHealth program rules and regulations to monitor provider compliance.
    • Participate in on-site visits to MassHealth members and/or providers 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, allied health clinical review teams, case managers and clinical managers.
    • 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 MassHealth program regulations policies and other documents.
    • Coordinate contacts with MassHealth providers to respond to inquiries pertaining to specific program areas.
    • Foster team environment and provide professional and clinical leadership to team members including allied health clinical reviewers, case managers, clinical managers, providers and administrative support staff as appropriate.
    • Direct team members in identifying and addressing issues involving clinical matters.
    • Interface with 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 prior authorization review processes and authorization of personal care attendant services, as appropriate.
    • 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, MassHealth member’s residence and state agency offices.
    • Perform other duties as assigned.

    Qualifications

    REQUIRED QUALIFICATIONS:

    • BA/BS required
    • Professional licensure or certification to practice in Massachusetts as required in one of the following allied health fields:
      • Occupational Therapy, Physical Therapy, Respiratory Therapy, Social Work or Speech and Language Pathology
    • 5-10 years of work experience
    • Min 2 years recent supervisory or management experience in a clinical care coordination role (full-time or part-time equivalent may be substituted).
    • 3 years of related work experience in prior authorization and working with disabled or long term care populations strongly preferred.
    • Knowledge of MassHealth regulations preferred.
    • Knowledge of MassHealth Hearing and Appeals process preferred. 
    • Strong analytical and problem solving skills preferred.
    • Ability to interpret appropriate regulations.
    • Ability to work independently and collaboratively.
    • Experience with Word and Excel and other desktop tools.
    • Valid Massachusetts driver’s license required.

    Additional Information

    * LI-SS1

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