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Brighton Marine · 5 hours ago

Clinical Care Coordinator

Boston, MA

Full-time

Hybrid

Mid Level

$80K/yr - $115K/yr

3+ years exp

Brighton Marine is a healthcare organization focused on delivering quality-driven services to military families. The Clinical Care Coordinator, a licensed RN or LCSW, is responsible for care coordination across behavioral and physical health domains, ensuring exceptional member-focused services and compliance with health policies.

Health CareHealth DiagnosticsMedicalNon ProfitPrimary and Urgent Care

No H1B

Responsibilities

Deliver coordinated services to all members, including those with complex medical, behavioral health, and developmental needs

Collaborate with the TPA regarding care coordination workflows, transitions of care, and high-risk member support

Ensure adherence to all DHA and TRICARE-related policies, including ECHO and ACD clinical oversight

Monitor key health indicators and recommend interventions to reduce avoidable emergency visits, hospitalizations, and readmissions

Preparation and submission of Clinical Data Requirements List (CDRL) reports to DHA

Coordinate with analysts and the TPA to verify data accuracy and completeness

Support reporting analysis to inform clinical care strategies and program improvements

Contribute to audit preparation and support compliance with documentation standards

Monitor clinical quality measures such as HEDIS and other TRICARE standards

Collaborate with internal teams to support and implement care interventions aligned with quality goals

Evaluate care plans, adjust as needed, and track member progress toward improved outcomes

Recommend process improvements to enhance clinical operations and care efficiency

Guide members through the healthcare system with a focus on advocacy, cost-effective resource utilization, and person-centered care

Educate members and providers on TRICARE benefits, community-based resources, and support programs

Facilitate effective transitions of care and ensure timely, coordinated service delivery across providers and systems of care

Support operational planning and team goals

Contribute to development of policies and procedures in alignment with contract expectations

Perform additional tasks to support the department and ensure timely service delivery

Other duties as assigned

Qualification

Care coordination experienceActive RN licenseLCSW licenseTRICAREEMR systems proficiencyRegulatory documentationDocumentation skillsOrganizational skillsCollaboration skillsCommunication skillsCritical thinkingProblem-solving skills