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 (Appointment Assistance) 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:

• Serve as a primary point of contact for members by providing support via inbound and outbound phone interactions
• Conduct outreach to healthcare providers and programs to obtain information on services and appointment availability, coordinate appointments, and ensure continuity of care.
• Work in a production-based environment with defined production and quality metrics.
• 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 network availability.
• Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.
• 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.