Temp Community Based Programs Coordinator
Job in
San Jose, Santa Clara County, California, 95199, USA
Listing for:
Santa Clara County Health Plan
Seasonal/Temporary
position
Listed on 2025-12-02
Job specializations:
-
Healthcare
Healthcare Administration
Salary/Wage Range or Industry Benchmark: 60111 - 87161 USD Yearly
USD
60111.00
87161.00
YEAR
Job Description & How to Apply Below
Overview
Temp Community Based Programs Coordinator
Salary Range: $60,111 - $87,161
The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.
TEMPORARY POSITION
FLSA Status: Non-Exempt
Department: Health Services
Reports To: Manager, Community Based Care Management
GENERAL DESCRIPTION OF POSITION
The Community Based Programs (CBP) Coordinator leads and participates in processes and projects to support and improve the operations of the Community Based Programs (CBP) team in alignment with organizational objectives, and in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements. In this role, the Coordinator supports the daily operations of CBP benefits, programs and strategies including serving as primary initial contact for specific referrals and authorization processes.
Responsibilities
Oversee the processes for referrals and authorizations, including processing the denial and disenrollment for Medi-Cal benefits under the CBP Team in accordance with state and federal regulatory requirements and SCFHP policies and procedures as set forth for each benefitPerform complete, accurate and consistent authorization processes including review of benefit eligibility and referrals, request and review of medical records and other documentation, as applicable, escalation to clinical staff or management for further determination, and process approval and denial letters or Notice of Action.Act as the primary initial contact for CBP referrals and communicate with internal departments for additional follow up as necessary and appropriate.Perform routine duties including accurate and consistent data entry into system software applications, managing and following up on call queues, and working to resolve member and provider inquiries in a timely manner.Serve as liaison with Grievance and Appeals (G&A) Department for support with CBP related reviews and resolution of member and/or provider issues submitted by G&AEnsure grievance and appeals cases are accurate and include the necessary elements for processing and resolving, giving special attention to those identified as "Expedite". Create clear and concise documentation in applicable system(s).Support needs of the CBP team including scheduling, coordinating and documenting meetings, maintaining records, generating mailing lists, setting up documents, onboarding staff and implementing other projects in support of CBP strategies.Support team staff on reviewing and providing input on member and provider facing materials, including program guides, training slides, and member information flyersSupport management in the process of approving policies, as well as the upload and updating of policy and procedures to Policy Tech platform.Follow established Health Services policies and procedures and use available resources to respond to member and/or provider inquiries and resolve any concerns in an accurate, timely, respectful, professional and culturally competent mannerBuild and maintain expertise and understanding of managed care, SCFHP policies and procedures, department functions and processes and relevant regulatory requirements.Collaborate with team members on improvement efforts across-departments regarding quality improvement projects, optimization of utilization management, and member satisfactionAssist in gathering and processing data for internal required reports and analysis.Attend and actively participate in daily, weekly, and monthly departmental meetings, in-services, training and coaching sessions.Process written and verbal notifications of authorization determinations to members and/or providers within regulatory processing time frames.Perform other duties as required or assigned.Qualifications
REQUIREMENTS - Required (R) Desired (D)
The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.
High school diploma or GED. (R)Associate's degree or equivalent experience, training or coursework. (D)Minimum two years of experience in customer service, program operations, health…
To View & Apply for jobs on this site that accept applications from your location or country, tap the button below to make a Search.
(If this job is in fact in your jurisdiction, then you may be using a Proxy or VPN to access this site, and to progress further, you should change your connectivity to another mobile device or PC).
Search for further Jobs Here:
