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Clinical Service Support Specialist

2 months ago

Vista, California, United States PHYSICIANS DATA TRUST Full time
Job Summary

We are seeking a highly skilled and detail-oriented Clinical Service Support Specialist to join our team at Physicians Data Trust. The successful candidate will provide critical support to our case management team, ensuring seamless coordination of care and efficient completion of Model of Care (MOC) tasks.

Key Responsibilities
  • Communication and Collaboration
    • Communicate effectively with case managers, healthcare providers, and other stakeholders in a timely, courteous, and professional manner.
    • Collaborate with the case management team to ensure all members receive comprehensive care coordination and MOC support.
  • SNP Coordination
    • Review daily hospital discharge reports to identify potential care coordination opportunities.
    • Develop and maintain transition of care (TOC) plans for D-SNP members upon hospital admission.
    • Retrieve and review LA Care health plan reports, including HRAs, to ensure accurate data entry and reporting.
    • Upload incoming faxes to Cozeva and maintain records of information received from D-SNP nurses.
    • Retrieve letters from the LA Care SFTP site and download Scan HRAs on a weekly basis.
    • Generate Risk Stratification Reports for CVPG and STV on a monthly basis.
    • Retrieve transfer-out/transfer-in reports from the LA Care SFTP site on a monthly basis.
    • Submit D-SNP program logs 1.5, 1.6, and 1.12 for CVPG and STV on a quarterly basis.
    • Submit Scan SNP Tracking and Metric logs on a quarterly basis.
    • Generate monthly LA Care reports for MOC 24.
  • Behavioral Health Integration
    • Integrate behavioral health services with primary care physicians and case managers as needed.
    • Identify and refer members to ambulatory case management when indicated.
  • Administrative Support
    • Ensure all specialty notes are shared with case managers and primary care physicians.
    • Coordinate transportation for members as needed.
    • Refer members to community-based resources when appropriate.
    • Assist case managers with all aspects of ambulatory case management within the scope of job responsibilities.
    • Prepare for D-SNP audits by maintaining accurate records and reports.
    • Develop and maintain a tracking system for health risk assessments, transitions of care, and inter-disciplinary care plan completion dates.
    • Populate and submit requested D-SNP reports on time to health plans.
    • Retrieve office records for health plan audits as requested.
  • Professional Development
    • Maintain a courteous and professional demeanor in all interactions with internal and external stakeholders.
    • Organize, manage, and prioritize workload effectively to meet productivity standards and deadlines.
    • Prepare daily, weekly, or monthly reports as requested.
    • Assist in the preparation of meetings and perform other duties as assigned.