New

Clinical Educator

Mass General Brigham Health Plan
United States, Massachusetts, Somerville
399 Revolution Drive (Show on map)
May 01, 2026
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 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 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 Bachelor's Degree required; Master's 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 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.