Clinical Support Coordinator 2

Responsibilities

• 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 training 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.

Requirements

Required Skills

• Detail-oriented
• Experience working in electronic medical record systems
• Experience with data entry and/or utilization management

Preferred Skills

• Health Plan and/or Medi-Cal experience/knowledge
• Excellent written and verbal communication
• Interest/passion for social services delivery

Education

• High School Diploma or equivalent

Software Skills

• Word
• Excel
• Outlook
• Teams