Clinical Services Coordinator, Intermediate
3 days ago
The Clinical Services Coordinator will play a vital role in ensuring the effective management of member care through outreach, engagement, and care coordination processes. This individual will interact with members and providers to address their health needs and support the Promise Case Managers and Social Workers in arranging follow-up appointments and services.
Key Responsibilities- Cultural Competence: Demonstrate the ability to work effectively, respectfully, and sensitively within the client's cultural context.
- Community Resource Knowledge: Possess knowledge of community resources and advocacy to support member care.
- Medi-Cal and Population Health Management: Incorporate Medi-Cal, Cal-AIM, and Population Health management requirements with NCQA/HEDIS measures with minimal supervision.
- Member Support: Resolve or direct member FAQs, including plan benefits, coverage, network, preferred facilities, provider searches, claims, authorizations, and more.
- Primary Point of Contact: Serve as the primary point of contact for members and providers.
- Administrative Support: Deliver administrative and clerical support to the Promise Case Managers as assigned.
- Liaison and Documentation: Act as a liaison to gather information and track patients referred to the care management program, documenting all patient-specific information in applicable systems.
- Telephonic Communication: Conduct telephonic communication with members as directed by established protocols to conduct general outreach, health risk assessment, or other program-specific needs.
- Program Management: Manage centralized program toll-free phone lines and email inbox to receive, respond, and triage program inquiries based on eligibility.
- Education: High school diploma or equivalent required.
- Experience: Minimum of 3 years of experience in a clinical practice, hospital, outpatient, health plan, community health, or care management setting.
- Language Skills: Bilingual in Spanish required.
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Clinical Services Coordinator
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