Clinical Support Coordinator 2

Talent Software Services, Inc.; États-Unis; Hybride; USD 40 000 - 52 000; Plein temps

Résumé du poste

Talent Software Services, Inc. is hiring for a Hybrid CalAIM Community Supports Coordinator. In this role you will review screening documents to determine eligibility, support referrals and enrollment, and process daily service authorizations and denials.

You will perform data entry and maintain case documentation, assist with provider invoicing, and participate in multidisciplinary teams to improve access to services and ensure regulatory compliance.

Qualifications

• High school diploma or GED required.
• 2–4 years of experience required.

Responsabilités

• Review CalAIM Community Supports screening to determine eligibility.
• Follow up with staff and providers to support enrollment of members.
• Process daily service authorizations and denials for Community Supports services.
• Data entry, tracking, and documentation for enrolled members (status, authorizations, encounters, care coordination).
• Reconcile provider invoicing and claims.
• Communicate with Community Supports Providers to ensure timely submission of deliverables.
• Educate internal teams and providers about CalAIM Community Supports services and referral process.

Connaissances

Detail oriented

Written and verbal communication

Data entry and/or utilization

Formation

High school diploma or GED

Outils

Word

Excel

Outlook

Teams

Description du poste

• Review CalAIM Community Supports Screening documents to determine member eligibility for CalAIM Community Supports.
• Follow up with internal staff and providers to support the successful referral and enrollment of members into CalAIM Community Supports services.
• Process daily service authorizations and denials for requested Community Supports services.
• Perform data entry, tracking, and case documentation for all members referred for services, including enrollment status, authorizations, encounter data, care coordination activities, clinical case records, and regulatory reports.
• Support with reconciling provider invoicing and claims.
• Support with sending communications to Community Supports Providers to ensure timely submission of deliverables and reports.
• Support with implementation of CalAIM Community Supports trainings to internal teams, external providers, and community-based organizations by providing ongoing education about CalAIM Community Supports services and referral process.
• Identify and help to address gaps/barriers in the care coordination process to improve member access to services.
• Review Provider reports to ensure accurate data collection and reporting.
• Respond to inquiries regarding service authorization request status.
• Actively participate in Multidisciplinary Team meetings to coordinate member care and support member retention in CalAIM Community Supports services.
• Conduct outreach calls to members, as needed, to verify engagement in Community Supports services.
• Participate actively in ensuring that all state and federal rules and regulations are followed.
• Perform other assigned duties, as required.

Description: Summary

• Review CalAIM Community Supports Screening documents to determine member eligibility for CalAIM Community Supports.
• Follow up with internal staff and providers to support the successful referral and enrollment of members into CalAIM Community Supports services.
• Process daily service authorizations and denials for requested Community Supports services.
• Perform data entry, tracking, and case documentation for all members referred for services, including enrollment status, authorizations, encounter data, care coordination activities, clinical case records, and regulatory reports.
• Support with reconciling provider invoicing and claims.
• Support with sending communications to Community Supports Providers to ensure timely submission of deliverables and reports.
• Support with implementation of CalAIM Community Supports trainings to internal teams, external providers, and community-based organizations by providing ongoing education about CalAIM Community Supports services and referral process.
• Identify and help to address gaps/barriers in the care coordination process to improve member access to services.
• Review Provider reports to ensure accurate data collection and reporting.
• Respond to inquiries regarding service authorization request status.
• Actively participate in Multidisciplinary Team meetings to coordinate member care and support member retention in CalAIM Community Supports services.
• Conduct outreach calls to members, as needed, to verify engagement in Community Supports services.
• Participate actively in ensuring that all state and federal rules and regulations are followed.
• Perform other assigned duties, as required.

Qualifications

• High school diploma or GED required.
• 2-4 years' experience required.

Software Skills Required

• Word
• Excel
• Outlook
• Teams

Work Set up

Hybrid

Top 3 Required Skills

• Detailed-oriented
• Excellent written and verbal communication
• Experience with data entry and/or utilization management

Preferred/Nice To Have Skills

• Health Plan and/or Medi-Cal experience/knowledge
• Experience working in electronic medical record systems
• Interest/passion for social services delivery