Clinical Care Coordinator - RN, LCSW, MSW (Remote within Florida)

Following a 2022 merger of CNSI and Kepro, Acentra Health combines clinical services, technology solutions, and data analytics to accelerate better health outcomes. This is a great time to join our team of passionate individuals working together to pursue the most effective solutions to today’s complex healthcare challenges. Our culture is fueled by passion and driven by purpose.

Clinical Care Coordinator - RN, LCSW, MSW (Remote within Florida)

• Are you an experienced Clinical Care Coordinator looking for a new challenge?
• Are you looking to join a team that ensures a collaborative and inviting culture where everyone can thrive?

If so, you might be our next new team member!

** This is a full-time, non-exempt (hourly) direct hire role with Benefits.

** The selected candidate must reside in and work remotely from Florida. **

** Hours: Monday through Friday, 8:00 AM to 5:00 PM Eastern. **

** Occasional Travel up to 5% annually may be required for this role. **

Who we need:

The Clinical Care Coordinator provides care coordination outreach activities to support the care management program. They will:

• Act as a patient advocate by providing immediate advocacy between the patient and providers to ensure the patient has what is needed.
• Utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract requirements, critical thinking, and decision-making skills to determine medical appropriateness while maintaining production goals and QA standards.
• Ensure day-to-day processes follow NCQA, URAC, and other regulatory standards.

Why us?

We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes.

Singularly Focused. Mission Driven.

Accelerating Better Outcomes is our Mantra! We are mission-driven to innovate health solutions that deliver maximum value and impact.

We do this through our people.

You will have meaningful work that genuinely improves people's lives across the country. We are a company that cares about our employees, and we give you the tools and encouragement you need to achieve the finest work of your career.

Benefits are a key component of your rewards package. Our benefits are designed to provide you with additional protection, security, and support for both your career and your life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more.

What you’ll do:

• Ensure the responsible delivery of comprehensive services to enrollees.
• Conduct general assessments for supervisor/lead interpretation/evaluation and assignment to case manager/health coach based on results.
• Plan and participate in interdisciplinary team meetings for collaborative assessment and coordination planning to ensure quality care.
• Proactively engage in the delivery of quality management program activities that are the direct responsibility of the Health Services team.
• Assist in the achievement and ongoing maintenance of accreditations for defined programs.
• Provide education and resources to beneficiaries/families/providers.
• Review and interpret patient records and compare against criteria to determine medical necessity and appropriateness of care; determine if the medical record documentation supports the need for services.
• Determine approval or initiate a referral to the physician consultant and process physician consultant decisions, ensuring the reason for the denial is described in sufficient detail in correspondence.
• Abstract review of related data/information accurately and timely on appropriate review tools by the proper means.
• Accurate and timely submission of all administrative and review-related documents to appropriate parties.
• Perform ongoing reassessment of the review process to offer opportunities for improvement and/or change.
• Foster positive and professional relationships and liaise with internal and external customers to ensure effective working relationships and team building to facilitate the review process.
• Responsible for attending training and scheduled meetings and maintaining and using current/updated information for review.
• Maintain medical records confiden