Nursing, Pharmacy, & Health Services - Clinical Support Coordinator 2

Location: Remote - CA

Duration: 3 Months (Possible Extensions)

Shift: 8AM - 5PM PST

Pay: $23.00 - $25.00 Per hr. on w2.

Position Overview: We are seeking a Clinical Support Coordinator 2 to support Community Supports services within a healthcare environment. This role will focus on CalAIM Community Supports referrals, member eligibility, service authorizations, utilization management activities, care coordination, documentation, and provider communication. The ideal candidate will have experience working with a medical population, particularly in utilization management, utilization review, medical review, prior authorization, referral processing, or healthcare coordination. Strong organizational skills, attention to detail, confidentiality, communication, and proficiency with Microsoft Office-especially Excel-are required.

Community Supports & Referral Management: Review CalAIM Community Supports screening documents to determine member eligibility for Community Supports services. Review referrals received for Community Supports services against established eligibility criteria. Verify member eligibility before processing referrals and authorizations. Follow up with internal staff and providers to support successful referral and enrollment of members into Community Supports services. Identify and help address gaps and barriers in the care coordination process to improve member access to services. Conduct outreach calls to members, as needed, to verify engagement in Community Supports services.

Authorization & Utilization Management: Process daily service authorizations and denials for requested Community Supports services. Perform authorization review and utilization management activities in accordance with applicable criteria. Respond to inquiries regarding the status of service authorization requests. Ensure referrals and authorization activities are processed accurately and timely. Support appropriate member access to authorized services.

Documentation, Data & Reporting: Perform accurate data entry, tracking, and case documentation for members referred for services. Maintain records related to:

• Enrollment status
• Service authorizations
• Encounter data
• Care coordination activities
• Clinical case records
• Regulatory reports
• Review provider reports to ensure accurate data collection and reporting.
• Support reconciliation of provider invoicing and claims.
• Maintain organized and confidential member information.

Provider & Internal Coordination: Communicate with Community Supports providers regarding deliverables, reports, referrals, and authorization status. Support timely submission of required provider documentation and reports. Participate in Multidisciplinary Team (MDT) meetings to coordinate member care and support member retention in Community Supports services. Support implementation of CalAIM Community Supports training for internal teams, external providers, and community-based organizations. Provide ongoing education regarding Community Supports services and the referral process. Work collaboratively with internal teams, providers, and community-based organizations.

Compliance & Customer Support: Follow applicable state and federal rules, regulations, policies, and procedures. Maintain confidentiality of member and healthcare information. Provide professional customer service and respond appropriately to inquiries. Perform other duties and assignments as required.

Required Qualifications: High school diploma or GED required.2-4 years of relevant professional experience required. Experience working with a medical/healthcare population. Experience with utilization management, utilization review, medical review, authorization, prior authorization, or referral processing. Experience reviewing referrals and determining eligibility. Experience processing or reviewing healthcare service authorizations. Strong verbal and written communication skills. Strong organizational and multitasking abilities. Ability to work independently and manage time effectively. Strong attention to detail. Ability to maintain confidential information. Proficiency with Microsoft Excel, Word, and PowerPoint. Comfortable working with healthcare applications and systems. Ability to quickly learn new systems, processes, and workflows. Must be located in California. Must be available to work 8:00 AM-5:00 PM PST, Monday through Friday.

Preferred Skills: Experience with Care Connect. CalAIM experience. Community Supports experience. Healthcare referral management. Prior authorization experience. Utilization management/utilization review experience. Experience with medical claims or provider invoicing. Experience working with multidisciplinary care teams. Experience communicating with healthcare providers or community-based organizations. Top Must-Have Skills Utilization Management / Authorization Review Medical Population / Healthcare Experience Referral & Eligibility Review Microsoft Excel & Healthcare Systems California Residency Availability for 8:00 AM-5:00 PM PST