Clinical Educator

Site: Mass General Brigham Health Plan Holding Company Inc.

Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham we are at the forefront of transformation with one of the worlds 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 welcoming and supportive environment that embraces their unique and varied backgrounds experiences and skills.

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

The Clinical Educator functions as a leader mentor and operational partner to promote high-quality compliant clinical review practices improve turnaround time and documentation standards and support workforce development system enhancements and organizational initiatives that drive positive change.

The Clinical Educator is responsible for assessing planning implementing and evaluating educational programs that enhance the knowledge skills and performance of clinical staff across the organization. This role has a strong focus on Utilization Management (UM) and Prior Authorization workflows supporting evidence-based practice regulatory compliance (CMS NCQA) and operational excellence for teams involved in care coordination case management and UM review functions. The Clinical Educator also supports education related to Appeals and Grievances processes to ensure staff understand documentation standards that impact audit readiness and determination integrity.

The Clinical Educator promotes high-quality compliant clinical review practices improve turnaround time and documentation standards and support workforce development system enhancements and organizational initiatives that drive positive change

Essential Functions
-Design and deliver orientation onboarding and continuing education for clinical teams including case managers care coordinators and nurses.

-Partner with Utilization Management Clinical Operations Compliance and IT leaders to support workflow optimization system enhancements and pilot initiatives.
-Translate regulatory accreditation and policy requirements into practical training for clinical and non-clinical staff.
-Develop and deliver education specific to Utilization Management and Prior Authorization workflows including clinical review documentation standards and medical necessity criteria application.
-Identify learning needs through skills assessments performance data audits and staff feedback.
-Support staff in applying evidence-based practices regulatory standards and care management guidelines.
-Provide real-time coaching mentoring and clinical support to staff in complex patient care situations or transitional care planning.
-Collaborate with clinical and administrative leaders to align education with organizational priorities policies and performance goals.
-Maintain and evaluate competency-based education modules and ensure training documentation is accurate and up to date.
-Participate in quality improvement initiatives and interdisciplinary committees related to patient outcomes and care transitions.
-Serve as a subject matter expert in care coordination case management and patient advocacy practices.
-Provide education and support related to Appeals & Grievances processes including documentation standards medical necessity rationale and regulatory timeframes that impact determination outcomes and audit readiness.

Education

• Bachelors Degree required; Masters Degree preferred

Licenses and Credentials

• Massachusetts Registered Nurse (RN)

Experience

• At least 3-5 years of experience in care coordination appeals and grievances utilization management (InterQual) or health plan compliance required
• At least 2-3 years of experience in staff education clinical instruction or preceptorship preferred
• At least 2-3 years of experience in working in a healthcare setting with complex patient populations and interdisciplinary collaboration preferred
• Experience with Articulate or Articulate 360 preferred
• Epic Tapestry experience highly preferred

Knowledge Skills and Abilities

• Expertise in care coordination models case management standards and discharge planning workflows.
• Knowledge of Utilization Management and Prior Authorization processes and workflows. Knowledge of Appeals & Grievances processes and the documentation and regulatory requirements that support defensible determinations.
• Familiarity with Epic systems related to care management or utilization management workflows.
• Experience applying medical necessity criteria such as InterQual or similar guidelines.
• Experience with e-Learning development tools such as Articulate.
• Strong presentation facilitation and instructional design skills.
• Excellent communication and interpersonal skills to work across multiple disciplines.
• Advanced proficiency with Microsoft PowerPoint for training development.
• Ability to manage multiple priorities and adapt to a dynamic clinical environment.
• Strong analytical and critical thinking skills.

Working Conditions

• This is a remote role that can be done from most US states but local candidates who can come in for occasional team meetings are preferred

Remote

399 Revolution Drive

40

Regular

Day (United States of America)

Pay Range

$79560.00 - $115720.80/Annual

Grade

7

At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

8925 Mass General Brigham Health Plan Holding Company Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .

Mass General Brigham Competency Framework