Clinical Coordinator

Corporate Transportation Group • Denver, CO

3d

About The Position

The Clinical Coordinator is responsible for reviewing and interpreting clinical documentation to support medical necessity determinations for Non-Emergency Medical Transportation (NEMT) services. This role ensures that all transportation requests—both in-state and out-of-state—are clinically appropriate, cost-effective, and compliant with regulatory and contractual requirements. The Clinical Coordinator serves as a key liaison between healthcare providers, case managers, and internal operations teams, ensuring that all eligibility decisions are well-supported, documented, and communicated effectively.

Requirements

• Demonstrated experience reviewing clinical documentation and making medical necessity determinations
• Strong knowledge of medical terminology, diagnoses, and clinical documentation interpretation
• Ability to assess transportation needs based on clinical conditions and functional limitations
• Excellent communication skills with the ability to interact with healthcare professionals and non-clinical stakeholders
• Strong analytical and decision-making skills with attention to detail
• Proficiency in Microsoft Office and healthcare management systems
• Must be able to participate in meetings, including virtual and in-person case reviews, as required

Nice To Haves

• Experience in healthcare, case management, utilization review, or a related field preferred
• Knowledge of Medicaid or managed care environments preferred

Responsibilities

• Review clinician documentation, medical records, and case notes to determine medical necessity for transportation services
• Evaluate and approve or deny trip requests based on established clinical guidelines and contract requirements
• Assess both in-state and out-of-state transportation requests to ensure appropriate level of service
• Determine the least costly, medically appropriate transportation mode based on member needs
• Monitor utilization trends of NEMT services within the assigned service area
• Identify patterns of over- or under-utilization and escalate concerns as appropriate
• Collaborate with internal teams to ensure efficient and appropriate use of transportation resources
• Communicate determinations (approvals/denials) clearly and timely to case managers, treatment facilities, and relevant stakeholders
• Provide clinical justification for all decisions, including participation in case discussions when required
• Serve as a subject matter expert on medical necessity for internal teams and external partners
• Participate in case management meetings with the Department, providers, and other stakeholders as needed
• Present and defend clinical determinations with supporting documentation and rationale
• Collaborate with case managers and healthcare professionals to clarify documentation or request additional information
• Ensure all activities comply with HIPAA and applicable state and federal regulations
• Maintain accurate, complete, and auditable records of all clinical reviews and determinations
• Ensure denial notices are accurate, compliant, and issued within required timeframes
• Coordinate with internal teams, including Financial Management and Operations, on pre- and post-trip documentation requirements
• Support the administration of statewide NEMT requests, including complex and non-traditional transport cases
• Assist in outreach and education efforts to explain NEMT services and eligibility criteria to stakeholders

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed