Clinical Care Manager

As a Clinical Care Coordinator at Rezilient Health, you will play a critical role in supporting patients, providers, and partners throughout the care continuum. You will lead the clinical onboarding of new contracts, manage complex tasks, coordinate referrals and authorizations, and ensure seamless communication between all stakeholders. Your work will directly impact patient outcomes, operational efficiency, and the overall success of our innovative Cloud Clinic model.

At Rezilient, we’re dedicated to revolutionizing primary and specialty care by delivering convenient, timely, and seamless access to healthcare. Our innovative hybrid Cloud Clinic model, powered by our onsite team of Medics and virtual Providers fosters a personalized and digital healthcare experience, putting the patient at the center of their care. By leveraging cutting-edge technology, we streamline care delivery, allowing our Providers to focus on patient well-being, and we continuously expand our specialty services to provide the most comprehensive and convenient healthcare possible.

• Lead the clinical onboarding process for all new contracts, ensuring timely collection of all necessary information and effective collaboration with Operations and Customer Success teams.
• Represent Rezilient Care Coordination in all onboarding meetings, serving as the primary point of contact for contract-related clinical questions.
• Design, build, and maintain a comprehensive care navigation database to support all care management activities.
• Ensure compliance with regulatory requirements and organizational policies during onboarding and data collection.

• Coordinate and manage patient referrals, including high-priority cases, ensuring timely follow-up and resolution of health concerns.
• Serve as a patient advocate by facilitating communication between patients, families, providers, and payers to optimize health outcomes.
• Communicate proactively with patients to provide updates, answer questions, and accommodate preferences related to referrals, orders, and care navigation.
• Identify and address barriers to care (e.g., transportation, financial, language, or health literacy challenges) and proactively support development of solutions to ensure patients receive timely, appropriate services.
• Maintain organized, accurate, and detailed records of all care coordination activities in accordance with HIPAA and all applicable privacy regulations.

• Lead and manage prior authorization processes, including peer-to-peer reviews, insurance rebuttal letters, single case agreements, and coordination with plan representatives.
• Facilitate the retrieval and secure transfer of medical records from previous specialists, manage release of information forms, and ensure all necessary documentation is available for patient care.
• Conduct comprehensive insurance benefit reviews for employer plans, documenting coverage for preventative services, behavioral health, specialty care, and pharmacy needs.
• Monitor and track the status of authorizations, referrals, and orders to ensure timely completion and communication to all stakeholders.

• Serve as the liaison with point solutions and cost containment partners, ensuring training, logins, and functionality are established for new launches.
• Collaborate with clinical teams, providers, and external partners to coordinate patient referrals, orders, and procedures in accordance with medical plan benefits and evidence-based guidelines.
• Communicate with insurance administrators and healthcare facilities to verify provider participation, coverage, pre-authorization requirements, and scheduling availability.
• Build and maintain strong working relationships with internal and external stakeholders to facilitate seamless care transitions.

• Develop and update care coordination workflows, training materials, and standard operating procedures to reflect best practices and regulatory changes.
• Lead initial, ongoing, and remediation training for new care coordinators to ensure consistent,…