Clinical Support Specialist

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This range is provided by SPECTRAFORCE. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

$19.00/hr - $20.00/hr

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Job Title: Clinical Support Coordinator 2

Location: Remote in California

Duration of the assignment: 6+ Months (Potential to extend or convert to a permanent role depending on the performance and business needs)

Shift timings: 8:30AM- 5:00PM Pacific Times.

The pay rate starts from $20/hour

Day to Day 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 trainings 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.

Required Skills (top 3 non-negotiables):

• Detailed-oriented
• Experience with data entry and/or utilization management

Preferred Skills (nice to have):

• Health Plan and/or Medi-Cal experience/knowledge
• Experience working in electronic medical record systems

Education Requirements: High School Diploma or equivalent

Software Skills Required: Word, Excel, Outlook, Teams

• Seniority level
  
  Entry level

• Employment type
  
  Full-time

• Job function Administrative
• Industries Pharmaceutical Manufacturing, Hospitals, and Hospitals and Health Care

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