Clinical Resource Coordinator
3 days ago
**Job Summary:** As a Clinical Resource Coordinator at Dignity Health Medical Foundation, you will play a critical role in ensuring accurate and efficient utilization review of medical records, benefit policies, and contractual agreements. Your strong clinical expertise and analytical skills will enable you to make informed decisions, collaborate with cross-functional teams, and develop support tools to enhance communication and quality of care.
Key Responsibilities:
- Conduct thorough reviews of medical records, benefit policies, and contractual agreements to determine medical coverage and appropriateness
- Process member records accurately and efficiently, ensuring timely updates and resolutions
- Collaborate with Member Services, Claim Department, physicians, and ancillary providers to resolve complex issues related to medical interpretation, research, or clarification
- Develop and maintain effective working relationships with internal stakeholders to ensure seamless coordination of member care
- Pursue ongoing education and training to stay current on industry developments, best practices, and regulatory requirements
Education and Experience:
- Bachelor's degree (BA or BS) or equivalent education and experience
- Current California Registered Nurse (RN) license
- Minimum 5 years of experience as an RN, with at least 2 years in a medical insurance environment
- Strong clinical expertise and analytical skills, with ability to interpret complex medical information and make informed decisions
Estimated Salary Range: $63,000 - $93,000/year
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