Clinical Service & Care Coordination Specialist II

CareSource; Accident (AR); On-site; USD 56,000 - 90,000; Full time

Job summary

CareSource is seeking a Complex Population Service Determination Specialist II to process medical necessity reviews and authorize home and community-based services. You will collaborate with providers, coordinate care, and support discharge planning for members.

The role requires an RN or health care Bachelor's degree, experience with Medicaid/Medicare, data entry and Microsoft Office skills, and a commitment to quality and cost-effective service delivery.

Qualifications

• Nursing degree from an accredited program or Bachelor’s in a health care field is required.
• Experience with Medicaid, Medicare, Commercial and Managed Care is preferred.
• Strong data entry skills and proficiency with MS Word, Excel and Access.
• Customer service oriented with professional phone etiquette.

Responsibilities

• Process medical necessity and service health care reviews for authorization.
• Assist with discharge planning and care coordination for members.
• Monitor delivery of healthcare services in a cost-effective manner.
• Collaborate with providers and Care Coordination to address concerns.

Skills

Medicaid experience

Care coordination

Quality audits

Customer service

Education

RN degree

Bachelor's degree in health care field

Tools

MS Word

MS Excel

MS Access

Job description

CareSource is seeking a Complex Population Service Determination Specialist II to process medical necessity reviews and authorize home and community-based services. You will collaborate with providers, coordinate care, and support discharge planning for members.

The role requires an RN or health care Bachelor's degree, experience with Medicaid/Medicare, data entry and Microsoft Office skills, and a commitment to quality and cost-effective service delivery.