Clinical Services Coordinator, Intermediate

Your Role

The Clinical Services Coordinator, Intermediate provides clinical support, utilization management, and support for members ranging from coordination of care to health risk assessments. In this role you will maintain an on-going case load in which you will assist the member, family and/or caregiver, and provider in the coordination and utilization management of services.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Requires 3 years of prior relevant experience
• Requires a High School Diploma, GED, or an additional 1 yr of relevant experience in lieu of diploma
• Demonstrated excellent communication skills with individuals, including physicians, members, patients, and service providers

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.

Your Work

In this role, you will:

• Process faxed/phoned in authorizations, requests and/or calls left on voicemail.
• Select support for Case Manager such as mailings, surveys
• Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation
• Support to Advanced/Specialist CSC
• Research member eligibility/benefits and provider networks
• Be responsible for establishing trusting relationships with members while providing person-centered support and services
• Perform telephonic member screenings to determine specific needs and services covered by the health plan; communicating and coordinating with PCPs, specialists, and other providers on behalf of members including appointment scheduling
• Initiate follow-up to confirm and coordinate additional needs of the member to support coordination of care across care settings and needs
• Document member specific care coordination and follow up actions in a timely manner according to regulatory standards in the appropriate information systems independently and in coordination with case managers and other team members

Your Work

In this role, you will:

• Process faxed/phoned in authorizations, requests and/or calls left on voicemail.
• Select support for Case Manager such as mailings, surveys
• Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation
• Support to Advanced/Specialist CSC
• Research member eligibility/benefits and provider networks
• Be responsible for establishing trusting relationships with members while providing person-centered support and services
• Perform telephonic member screenings to determine specific needs and services covered by the health plan; communicating and coordinating with PCPs, specialists, and other providers on behalf of members including appointment scheduling
• Initiate follow-up to confirm and coordinate additional needs of the member to support coordination of care across care settings and needs
• Document member specific care coordination and follow up actions in a timely manner according to regulatory standards in the appropriate information systems independently and in coordination with case managers and other team members