Clinical Care Coordinator

3 days ago


Remote, Oregon, United States Enterprise Engineering Full time
Job Overview

Enterprise Engineering seeks a skilled Clinical Care Coordinator to promote quality and cost-effective outcomes for a population by facilitating collaboration and coordination across settings.

This role involves reviewing patient records and providing recommendations to ensure members receive the services and resources required to meet desired health and social outcomes.

The ideal candidate will have a strong working knowledge of MCG, InterQual, and NCQA standards, as well as a minimum of 2 years of experience in medical management clinical functions.

Responsibilities include:

  • Performing prospective, retrospective, or concurrent medical necessity reviews for an assigned panel of members
  • Collaborating with the Medical Director to ensure the integrity of adverse determination notices
  • Ensuring discharge planning is timely and appropriately communicated to the transition of care teams
  • Meeting or exceeding productivity targets set forth
  • Serving as a resource to non-clinical team members

Qualifications include an Associate's degree in Nursing, preferred, and a strong understanding of clinical criteria and guidelines.


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