Clinical Services Coordinator, Advanced - Specialty Services

Your Role

The Specialty Services team is a branch off the MCS Intake team. The Clinical Support Coordinator will report to the Specialty Services Manager. In this role you will be required to process phone and faxed requests for Continuity of Care, Access to Care for both commercial and Medi-Cal membership. This role may also require Peer or Peer provider support and other duties within Medical Care Solutions.

Your Knowledge and Experience

• Requires a high school diploma or equivalent
• Requires at least 5 years of prior relevant experience
• Requires flexibility and insightfulness
• Requires the ability to work independently using documented processes
• Requires the ability to make decisions quickly, effectively, and without doubt
• Previous MCS Intake experience preferred but not required
• 3 years of work experience within the Medical Care Solutions' Utilization Management Department or a similar medical management department at a different payor, facility, or provider/group preferred. Experience with Medicare and/or Medi-Cal is preferred.
• In-depth working knowledge of the prior authorization review and non-clinical business rules and guidelines, preferably within the Pre-service area.
• In-depth working knowledge of the systems/tools utilized in the UM authorization functions such as AuthAccel, Facets, AEVS and PA Matrix or other systems at a different payor, facility, or provider/group preferred.
• Ability to work in a high-paced production environment with occasional overtime needed (including weekends) to ensure regulatory turnaround standards are met.
• Knowledge of UM regulatory TAT standards
• Knowledge of clinical workflow to assist nurses with case creation, research/issue resolution and other UM related functions, as necessary.