Clinical Support Coordinator, Remote

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world's leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience - a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise within a consciously inclusive environment where diversity is celebrated.  

We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more. 

The Clinical Support Coordinator (CSC) is responsible for providing administrative support to the Utilization Management Care Managers (UMCMs) and the Utilization Management (UM) department. The CSC is responsible for processing authorizations, referrals, and managing provider notifications per the established contract benefit, and policies and procedures. The primary function of the position includes the research, analysis, resolution, and data entry of service requests and notices received internally and externally via electronic portal, fax, telephone, mail, or email. In addition, the incumbent must ensure that authorizations are updated appropriately and processed in a timely, accurate, manner in compliance with performance measures per turnaround time and quality review standards. The incumbent is responsible to manage inbound calls following CMS regulations and internal processes and perform outbound telephone calls as per authorization requirements. The CSC is responsible for the generation and management of various reports. Additionally, the incumbent will assist in various UM projects, provider and member outreach initiatives, and other projects and duties as assigned.

Principal Duties and Responsibilities:

   Provide support to UM Care Managers to ensure provider and member customer satisfaction.
   Process authorizations and referrals using desktop procedures and workflows
   Outreach providers for needed clinical information and upload to appropriate authorization in Mass General Brigham Health Plans' online provider portal
   Strong knowledge and understanding of processing requests per Medicare, Medicaid, and commercial lines of business
   Meet quality standards per NCQA, CMS, DOI, and health plan regulations
   Ensure customer satisfaction to providers and members
   Respond in a timely and accurate manner to internal and external customer inquiries as per policies and procedures. Escalate urgent issues as appropriate.
   Achieve and maintain compliance with telephone accessibility
   Communicate and collaborate with colleagues to identify and resolve unique circumstance and/or errors regarding authorizations and/or overall internal processes
   Cross-train to provide coverage within the Clinical Support UM department   
   Provide alternate coverage during staff absences and position vacancies, as directed
   Excellent communication skills; verbal, written, and interpersonal skills
   Ability to efficiently prioritize and organize work 
   Keen attention to detail, analytical problem solver
   Ability to be creative, develop solutions to problems with a demonstrated use of critical thinking skills
   Provide support for various care management and member outreach initiatives
   Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise
   Attend meetings as required
   Coordinate and assist with team projects as directed     
   Participate in inter-departmental meetings and trainings as required
   Create and maintain departmental process documents
   Hold self and others accountable to meet commitments.
   Ensure diversity, equity, and inclusion are integrated as a guiding principle.
   Persist in accomplishing objectives to consistently achieve results despite any obstacles and setbacks that arise.
   Build strong relationships and infrastructures that designate Mass General Brigham Health Plan as a people-first organization.
   Other duties as assigned with or without accommodation.

Qualifications: 

   Associate or High School Diploma degree required.
   Health care delivery, medical billing, coding and/or customer service experience.
   Knowledge of utilization management process (i.e., Health Center, Hospital, Insurance Company, Physician office)  
   Knowledge of Utilization Management regulations and standards
   Experience with Medicare, Medicaid, and Commercial lines of business
   Bilingual preferred.

Skills/Abilities/Competencies: 

   Demonstrate Mass General Brigham Health Plans core brand principles of always listening, challenging conventions, and providing value. 
   Bring fresh ideas forward by listening to and working with employees and the people we serve. 
   Respect the talent and unique contributions of every individual and treat all people in a fair and equitable manner.  
   Strong, demonstrated track record of an ability to execute on time, on budget, and on scope. 
   Strong aptitude for technology-based solutions. 
   Ability to inject energy, when and where it's needed.  
   Current in healthcare trends.
   Demonstrated forward, visionary thinking; ability to see "what is" and envision "what could be."
   Ability to develop, introduce, defend, and gain support for a new ideas and approaches. 
    Excellent leadership skills and leadership track record.
   Ability to translate and communicate complex topics in a variety of forums, tailoring communications to effectively fit and influence the targeted audience, strong executive presence, presentation, and communication skills. Strong verbal, active listening, and written communication skills required.  
   Ability to view the long-range trends and cycles of the business and industry and see the "big picture." 
   Ability to apply a variety of strategic frameworks to analyze problems and to guide and develop solutions.
   Ability to challenge the status quo and drive innovative thinking and the capability to successfully implement strategy. 
   Excellent interpersonal skills, including the ability to influence others at all levels of an organization.  
   Strong EQ; exercises self-awareness; monitors impact on others; is receptive to and seeks out feedback; uses self-discipline to adjust to feedback.
   Unquestionable integrity.