Clinical Services Coordinator, Intermediate

Your Role

The Behavioral Health Team is responsible the coordination of care and assistance in finding providers for members in need. The Clinical Services Coordinator (CSC), Intermediate will report to the Supervisor, Operations -Behavioral Health . In this role you will be for supporting clinical staff day-to-day operations.

Your Work

In this role, you will:

• Work in a production-based environment with defined production and quality metrics.
• Process Faxed /Web Portal /Phoned in Authorization or Hospital Admission Notification Requests, Utilization Management (UM)/Case Management (CM) requests and/or calls left on voicemail.
• The CSC will oversee designated queues and workstreams, with standardized reports to detect and address member needs.
• 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.
• Provide support to Case Management and/or Utilization Management team on member eligibility, benefits, and provider networks
• Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.
• Serves as an initial point of contact for providers and/or members in the behavioral health management process by telephone or correspondence.
• Assists with system letters, requests for information and data entry.
• Provides administrative/clerical support to Behavioral Health management.

Your Knowledge and Experience

• Requires a high school diploma or equivalent
• Requires at least 3 years of prior relevant experience
• Desired certification and/or training as a patient advocate, health coach, care navigator or other relevant health plan experience
• 2-year work experience with managed health care utilization or case management department or a similar medical management department at a different payor, facility, or provider/group.
• Ability to work in a high-paced production environment with occasional overtime needed (including weekends) to ensure regulatory turnaround standards are met.
• Knowledge of clinical workflow to assist BH Care Managers with case creation, research/issue resolution and other UM related functions, as necessary.