Clinical Care Coordinator

4 weeks ago


San Francisco, California, United States Enterprise Engineering Services Full time
Job Summary

Enterprise Engineering Services is seeking a skilled Clinical Care Coordinator to join our team. In this role, you will be responsible for promoting quality and cost-effective outcomes for our members by facilitating collaboration and coordination across settings. You will identify member needs, plan for care, monitor the efficacy of interventions, and advocate to ensure members receive the services and resources required to meet desired health and social outcomes.

Key Responsibilities

Perform prospective, retrospective, or concurrent medical necessity reviews for an assigned panel of members
Review cases for medical necessity and apply the appropriate clinical criteria
Collaborate with the Medical Director to ensure the integrity of adverse determination notices
Ensure discharge planning is timely and appropriately communicated to the transition of care teams
Meet or exceed productivity targets set forth

Requirements

Associate's degree in Nursing, preferred
Minimum 2 years of experience in medical management clinical functions
Working knowledge of MCG, InterQual, and NCQA standards

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