Job Description

Your Role

The Clinical Services Coordinator (CSC) will report directly to the supervisor of care management support operations and will serve as an initial point of contact for providers and members in the medical management process by telephone or correspondence. The CSC will interact telephonically with members as per established protocol or direction to ensure that members are effectively and efficiently managed through the medical/disease management process as needs require and in helping the RN care manager or social worker in arranging appropriate medical equipment (DME), home health, follow-up appointments, and other services related to care coordination.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In this role, you will:

• Telephonic outreach to conduct the Health Risk Assessment (HRA) with the member
• Telephonic outreach to members as directed by protocol or RN care manager or social worker.
• Assists with system letters, requests for information and data entry.
• Back up to phones when needed.
• Provides administrative/clerical support to medical and disease management programs.
• Acts as a liaison, gathers information, and track all patients referred to the care management programs.
• Assists in coordinating care for specific high risk/high-cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc.
• Documents all patient specific information in appropriate information systems.
• Assists in verifying health plan benefits and coordinating ambulatory services.
• Demonstrates cultural competence to work effectively, respectfully, and sensitively within the client’s cultural context.
• Assists with precepting responsibilities for new hires and auditing efforts.

Note: The selected candidate will be asked to come onsite to the Long Beach, CA office 2 times per month

Your Knowledge and Experience

• Requires a High School Diploma or GED or 1 year of additional relevant experience in lieu of a diploma
• Requires a minimum of 3 years of relevant experience
• Requires a minimum of 1 year experience in a managed care environment.
• Bi-Lingual, English/Spanish is required
• Experience using MS Office applications including Word, Excel, PowerPoint, Outlook and Teams. Experience using Salesforce preferred.
• Knowledge of clinical workflow to assist nurses with research and issue resolution preferred
• Health insurance/ managed care experience (Commercial, Medicare, and Medi-Cal) preferred. Knowledge of Medicare eligibility criteria preferred.
• Experience working with community resources and member advocacy preferred
• Experience working in an integrated practice in a triad model of care preferred

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.