Clinical Services Coordinator, Advanced

Your Role

The Care Management team is a member facing team that provides care coordination to our most vulnerable members to improve the health equity and quality for each person we serve. The Clinical Service Coordinator, Advanced will report to the Supervisor of Operations, Care Management. In this role you will serve as 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 coordinate member’s social determinant of health needs. The CSC will assist members with linking them to resources that are needed and provide care coordination that is individualized for each member identify for services. The main goal of this team is to link members to the services they need to improve their health equity and health quality. 

Your Work

In this role, you will:

• Coordinating care management requests, managing special processes and case types, and responding to calls left on voicemail
• The CSC will oversee designated queues and workstreams, with standardized reports to detect and address member needs.
• Handle customer/provider problematic calls  
• Check member history for case management triage and research member eligibility/benefits and provider networks 
• Demonstrates cultural competence to work effectively, respectfully, and sensitively within the client's cultural context
• Seeks and accepts referrals for target patient populations, i.e. fragile seniors, catastrophic and transplant cases, frequent utilizers of ER and inpatient services, and patients diagnosed with specific diseases
• Acts as a liaison, gather information and track all patients referred to the care management programs and community resource referrals
• 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.

 

Your Knowledge and Experience

• Requires a high school diploma or equivalent 
• Requires at least 5 years of prior relevant experience
• Desired Certification and/or training as a patient advocate, health coach, care navigator
• Health insurance/managed care experience (Commercial, IFP, Medicare, and Medi-Cal)
• Community resources and advocacy 
• Practice integration in a triad model of care