Clinical Services Coordinator, Specialist (Bilingual)

Your Role

The Clinical Service Coordinator Specialist is responsible for the daily operations within the PHP Care Management Department for non-clinical functions. The Specialist will support Case Management services provided by the PHP-CM coordinator staff under management's direction. The Specialist (Lead) will help coordinate care for members in accordance with the BSC Promise Health Plan Care Management Program, responsible for supporting the team Supervisor and performing leadership duties when Supervisor/ Manager is absent or out of the office on all nonclinical functions and practices. The Coordinator Specialist will help develop strategies alongside supervisor to ensure team members meet daily workload and stay in compliance with daily management system vision board.

Your Work

In this role, you will:

• Responsible for daily administrative clinical service coordinator operation of PHP CM department including efficient workflow. Serve as resource and/or educator to the clinical service coordinator team, members, and providers as needed. Daily monitor and review the PHP-CM coordinator staff activities and provide feedback to staff consistently.
• Collaborate with management on new policies, procedures, and guidelines to enhance the effectiveness of coordinators workflow. Coordinating with management to organize the department workload and establish work standards to promote efficiency and productivity. Put together quarterly customer surveys and track progression throughout the year. Manage coordinators dashboard and provide education/training to ensure that coordinators meet goals.
• Interact with internal and external customers to promote effective communication, education, and problem resolution Interface with other departments in regard to PHP-CM and operational workflow.
• Demonstrate the ability to make decisions, take appropriate action and follow tasks through completion. Always maintain organizational confidentiality. Comply with all organizational policies regarding ethical and compliant business practices. Additional responsibilities at the discretion of Management.
• Generates and monitors comprehensive detailed reports on team performance, active processes, and daily productivity
• Supports team members with issue resolution, answer questions, help with team problems and oversees team members work quality and guideline compliance
• Assists with work distribution
• Reports out to management, compliance on team performance such as Quality Monthly report
• Conduct daily and monthly huddles/meetings
• Provide help to management, including projects, daily management meetings, training, updates on team performance
• Process faxed/phoned in authorizations, UM/CM requests, special processing/case types and/or calls left on voicemail
• Monitor specific queues/workstreams and generates pre-defined reports to identify and resolve common errors
• Handle customer/provider problematic calls
• Check member history for case management triage and research member eligibility/benefits and provider networks
• Assign initial EOA days, or triage to nurses, based on established workflow

Your Knowledge and Experience

• Requires a high school diploma or equivalent
• Bilingual Spanish Required
• Requires advanced knowledge within a specific discipline typically gained through extensive work experience and/or education.
• Typically, requires minimum of 7 years of experience. May require vocational or technical education in addition to prior work experience.
• Understanding of basic member engagement principles, techniques and practices and their application to complex social and clinical problems
• Knowledge base on specific health issues and medical terminology