The Clinical Service Coordinator, Specialist responsible for the daily operations within the Promise Health Plan – Case Management Department for non-clinical functions. The Lead will be responsible for the coordination of Health Risk Assessment / Individualize Care Plan Outreach Process, Case Management services, Transitions of care services provided by the PHP-CM coordinator staff under the direction of management. The Lead will assist in coordinating care for members in accordance with the BS... more details
Your Role
The Clinical Service Coordinator, Specialist responsible for the daily operations within the Promise Health Plan – Case Management Department for non-clinical functions. The Lead will be responsible for the coordination of Health Risk Assessment / Individualize Care Plan Outreach Process, Case Management services, Transitions of care services provided by the PHP-CM coordinator staff under the direction of management. The Lead will assist in coordinating care for members in accordance with the BSC Promise Health Plan Care Management Program. The Lead is responsible to Support team supervisor and perform management duties when supervisor/ manager is absent or out of the office on all nonclinical functions and practices.
Your Work
In this role, you will:
Process faxed/phoned in authorizations, UM/CMrequests, special processing/case types and/or calls left on voicemail
Monitor specific queues/workstreams and generate pre-defined reports to identify and resolve common errors
Handle customer/provider problematic calls
Check member history for case management triage and research member eligibility/benefits and provider networks.
Assign initial EOA days, or triage to nurses, based on established workflow
Responsible for daily administrative clinical service coordinator operation of PHP – CM department including efficient workflow
Serve as resource and/or educator to the clinical service coordinator team, members, and providers as needed. Daily monitor and review the PHP-CM coordinator staff activities and provide feedback to staff on a consistent basis
Collaborate with management on new policies, procedures, and guidelines to enhance the effectiveness of coordinators’ workflow. Coordinating with management to organize the department workload and establish work standards to promote efficiency and productivity. Put together quarterly customer surveys and track progression throughout the year. Manage coordinators’ dashboard and provide education/training to ensure that coordinators’ meet goals
Interact with internal and external customers to promote effective communication, education, and problem resolution Interface with other departments regarding PHP-CM and operational workflow
Demonstrate the ability to make decisions, take appropriate action and follow tasks through completion. Always maintain organizational confidentiality. Comply with all organizational policies regarding ethical and compliant business practices. Additional responsibilities at the discretion of Management
Generates and monitors comprehensive detailed reports on team performance, active processes, and daily productivity
Supports team members with issue resolution, answer questions, helps with team problems and oversees team members’ work quality and guideline compliance
Assists with work distribution
Reports out to management, compliance on team performance such as Quality Monthly report
Supports and engages with HRA vendors by assisting with oversight of the HRA business operations
Conduct daily and monthly huddles/meetings
Provide help to management, including projects, daily management meetings, training, updates on team performance
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