Clinical Care Coordinator
6 days ago
We are seeking a skilled Clinical Care Coordinator to join our Medical Management team at Clinicas del Camino Real. This is an exciting opportunity to work in a fast-paced environment and make a meaningful impact on the lives of our members.
Job Description:The Clinical Care Coordinator will be responsible for conducting clinical reviews of service requests, ensuring medical appropriateness and necessity using considerable clinical judgment and knowledge of medical policies, clinical guidelines, and benefit plans. The ideal candidate will possess strong analytical and problem-solving skills, with the ability to communicate effectively with internal and external stakeholders.
The successful candidate will also have experience working in a similar role, with a strong understanding of federal and state regulations/requirements, including HIPAA and JCAHO or NCQA criteria. Additionally, they will have excellent verbal and written communication skills, with the ability to build effective working relationships.
This role requires the ability to work independently, while also being part of a dynamic team. The successful candidate will be able to prioritize tasks effectively, manage multiple projects simultaneously, and maintain accurate records and documentation.
In addition to the above responsibilities, the Clinical Care Coordinator will also be expected to develop determination recommendations, present cases to the Medical Director, and interact with providers and members as necessary. They will also be required to attend meetings and participate in training sessions as assigned.
RequirementsTo be considered for this role, you will need:
- A graduate degree in nursing from an accredited program (BSN or MSN preferred)
- An active, valid, and unrestricted State of California Registered Nurse license
- At least 2 years of experience in a similar role, preferably in a fast-paced insurance or healthcare setting
- Strong analytical and critical thinking skills, with the ability to identify complex care coordination opportunities
- Excellent verbal and written communication skills, with the ability to build effective working relationships
- A strong understanding of standardized clinical guidelines/criteria, such as MCG, InterQual, Medi-Cal Criteria, and Medicare Criteria
- Varied background in nurse disciplines, such as acute inpatient care, home health, outpatient clinic, behavioral health, and ancillary services
The salary for this role is estimated to be around $75,000-$90,000 per year, depending on experience. We also offer a comprehensive benefits package, including medical, dental, and vision insurance, as well as retirement savings and paid time off.
If you are a motivated and detail-oriented individual with a passion for delivering high-quality patient care, we encourage you to apply for this exciting opportunity. Please submit your resume and cover letter to learn more about this role.
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