Clinical Care Coordinator

Job Description

Job Description

Description:

Title: Clinical Care Coordinator

Job Type: Full-time

Location: Hybrid from Brighton, MA

FLSA Status: Exempt

Position Summary

The Clinical Care Coordinator is a licensed Registered Nurse (RN) OR Licensed Clinical Social Worker (LCSW) responsible for the delivery and oversight of care coordination functions across behavioral and physical health domains. This role is a critical contributor to the US Family Health Plan at Brighton Marine by supporting and delivering exceptional quality-driven, member-focused services for active-duty family members and military retiree beneficiaries.

Key Responsibilities

Care Coordination Support

• 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.

DHA CDRL & Reporting Support

• 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.

Clinical Quality & Performance Improvement

• 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.

Member & Provider Interaction

• 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.

Administrative Support

• 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.

Qualifications

Education & Experience

• Minimum 3-5 years of care coordination or case management experience.
• Familiarity with TRICARE, ECHO, ACD, and DHA/DoD health system standards preferred.

Licensure & Certifications

• Active RN license or LCSW in the state of Massachusetts, Connecticut, New Hampshire or Rhode Island.

Skills & Competencies

• Strong documentation, organizational, collaboration and communication skills.
• Critical thinking and problem-solving skills.
• Proficiency in EMR systems, reporting tools, and regulatory documentation.

Physical Nature of the Job

Some elements of the job are sedentary, but the employee will be required to stand for periods of time or move throughout the campus.

Equal Opportunity Employer Statement

Brighton Marine is an Equal Opportunity Employer. We prohibit discrimination and harassment of any kind based on race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), national origin, age, disability, genetic information, protected veteran status, or any other characteristic protected by federal, state, or local law. We strongly encourage applications from veterans and individuals with disabilities. Accommodations are available upon request for candidates taking part in all aspects of the selection process.

Work Authorization

Candidates must be authorized to work in the United States without sponsorship now or in the future.