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UMass Med School

RN Clinical Coordinator

Westborough, MA · On-site

$100K/yr

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 ...

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How much do masshealth jobs pay per hour?

As of Sep 7, 2026, the average hourly pay for masshealth in the United States is $26.34, according to ZipRecruiter salary data. Most workers in this role earn between $15.14 and $30.77 per hour, depending on experience, location, and employer.

What is a MassHealth?

A MassHealth job typically refers to a role within the Massachusetts Medicaid program, which provides healthcare coverage to eligible low-income residents. These jobs can include positions in customer service, case management, policy development, and healthcare administration. Employees may work for the state government or organizations that support MassHealth operations. Responsibilities can range from processing applications to assisting members with benefits and services. These roles are essential in ensuring access to healthcare for vulnerable populations.

What are the key skills and qualifications needed to thrive in the MassHealth position?

To excel in a MassHealth Specialist role, you need a deep understanding of health insurance eligibility, state and federal healthcare regulations, and strong administrative skills, often supported by experience in healthcare or social services. Proficiency with case management systems, enrollment platforms, and documentation tools is crucial. Excellent interpersonal skills, attention to detail, and problem-solving abilities help navigate complex cases and support vulnerable populations. These competencies ensure accurate enrollment, compliance, and effective assistance for MassHealth applicants and members.

What are some common challenges faced by MassHealth specialists, and how are they addressed on the job?

MassHealth Specialists often encounter challenges such as interpreting complex eligibility requirements, managing high caseloads, and assisting applicants with limited documentation or language barriers. To address these, specialists receive extensive training, work closely with their teams, and utilize translation and support services for clear communication. Maintaining updated knowledge of policy changes is also essential, which is typically supported by regular staff meetings and ongoing professional development. By collaborating with colleagues and leveraging organizational resources, specialists can provide accurate and timely support to those in need.

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Masshealth jobs near you
Infographic showing various Masshealth job openings in the United States as of August 2026, with employment types broken down into 81% Full Time, 16% Part Time, and 3% Temporary. Highlights an 97% In-person, and 3% Remote job distribution, with an average salary of $54,791 per year, or $26.3 per hour.

Clinical Coordinator

University of Massachusetts Medical School

Westborough, MA • On-site

$90K - $100K/yr

Full-time

Re-posted 20 days ago

Key responsibilities

  • Provide clinical direction, supervision, and support to the clinical review team in determining eligibility and authorizing services for members.

  • Supervise and perform approval, modification, or denial of requested services in accordance with program standards and regulations.

  • Coordinate contacts with providers, respond to inquiries, and prepare reports related to clinical determinations and appeals.

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 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.

Qualifications
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

Additional Information
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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