Job description

JOB PURPOSE:

The Clinical Review Coordinator is responsible for supporting the Clinical Review team, ensuring compliance with its policies and procedures, and identifying performance improvement opportunities. The Clinical Review Coordinator will ensure timely processing of provider service requests and authorizations, accurate and thorough documentation in the documentation database, and timely provider notification. This role will also be responsible for supporting the clinical team, facilitating communication with PACE site Interdisciplinary Teams (IDT), and following initiatives as directed by the Clinical Review Coordinator Supervisor and Senior Director of Clinical Review.

JOB RESPONSIBILITIES:

Supports the Clinical Review department by processing requests for authorization that are received via email and fax box, and by assigning to appropriate clinical staff for review. Data entry for requests in the documentation database and tracking requests until completion. Manages incoming call inquiries and emails and addresses them in a timely manner. Creates approval and denial letters, including letter composition, saving in the appropriate area in the documentation system, and faxes letters to providers within required timeframes.

Participates in team and Clinical Review All Staff meetings and training as assigned.

Assists with internal and external audits as needed.

Recognizes and refers potential quality of care concerns to Quality Management. Maintains confidentiality of all information in compliance with State and Federal Law and CenterLight Healthcare policy. Identifies and communicates system improvements or individual care issues that would cause failure to provide appropriate care or meet service requirements.

Trains new staff on departmental processes, procedures, and policies.

Interfaces with various departments and PACE sites, delegated entities, medical groups, and network physicians to ensure timely resolution of inquiries.

Adheres to company and department policies and procedures.

Performs other duties as assigned.

SALARY RANGE:

Minimum: $48,000.00

Maximum: $58,000.00

QUALIFICATIONS:

Education: Bachelor's or Associate's Degree in business, health care, or related field.

Experience: Two years’ experience in a managed care healthcare setting, preferable. Experience with Coding (ICD-10), Authorizations, Call Center setting, and Provider Relations, preferable.

Other Requirements:

Within 45 days, must pass a proficiency test of Care Compass, used daily.

Proficient in computer programs such as Microsoft Office, and Microsoft Excel, and knowledge of Access or other database programs a plus.

Excellent verbal and written communication skills.

Excellent problem solving and analytical skills.

Accurate attention to detail with strong organizational skills.

Demonstrated ability to manage multiple projects and be flexible.

Able to travel to any of the CLHC locations, as needed.

Job Type: Full-time

Pay: $48,000.00 - $58,000.00 per year

Benefits:

• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Medical specialties:

• Geriatrics

Physical setting:

• Clinic

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Ability to commute/relocate:

• New York, NY 10029: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• What is your expected salary range?
• Do you have the COVID Vaccination?

Education:

• Associate (Preferred)

Experience:

• clinical review: 2 years (Preferred)

Work Location: In person

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