CLINICAL PROGRAMS COORDINATOR

C2Q Health Solutions•Plaza, ND

7d•$50,000 - $60,000

About The Position

JOB PURPOSE: The Clinical Programs Coordinator supports Clinical Review and Transitions of Care teams by ensuring compliance with policies, timely processing of provider requests, accurate documentation, and effective communication with PACE site Interdisciplinary Teams (IDT) and external providers. This role also assists with performance improvement initiatives as directed by the Clinical Program leadership. JOB RESPONSIBILITIES: Transitions of Care (TOC): Reinstate home care hours and process DME orders. Schedule transportation and post-hospitalization appointments (including specialists and CBPCP if needed). Enter service plans and authorizations for subacute rehab and inpatient stays. Ensure follow-up appointments are completed; retrieve notes from provider offices. Perform other related duties as assigned. Clinical Review: Process authorization requests received via email or fax and assigns to clinical staff. Enter and track requests in the documentation system until completion. Manage inquiries via phone and email promptly. Prepare and send approval/denial letters within required timeframes. Participate in team meetings, audits, and staff training. Identify and report quality-of-care concerns to Quality Management. Recommend system improvements and assist in resolving care issues. Train new staff on departmental processes and policies. Collaborate with internal departments, PACE sites, and network providers for timely issue resolution. Maintain confidentiality, adhere to HIPAA law and company policies. Perform other related duties as assigned.

Requirements

Bachelor's or Associate's Degree in business, health care, or related field.
Two years’ experience in a managed care healthcare setting, preferably.
Must have previous Authorizations experience.
Typewriting Test must be taken. Results should be more than 40 WPM with Good or above accuracy.
Within 45 days, must pass a proficiency test of Care Compass, used daily.
Proficient in computer programs such as Microsoft Office, and basic Microsoft Excel, Teams & SharePoint.
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.
Individuals must be able to sustain certain physical requirements essential to the job. This includes, but is not limited to: Standing – Duration of up to 6 hours a day. Sitting/Stationary Positions – Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods. Lifting/Push/Pull – Up to 50 pounds of equipment, baggage, supplies, and other items used in the scope of the job using OSHA guidelines, etc. Bending/Squatting – Have to be able to safely bend or squat to perform the essential functions under the scope of the job. Stairs/Steps/Walking/Climbing – Must be able to safely maneuver stairs, climb up/down, and walk to access work areas. Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (ie. typing, use of supplies, equipment, etc.) Sight/Visual Requirements – Must be able to visually read documentation, papers, orders, signs, etc., and type/write documentation, etc. with accuracy. Audio Hearing and Motor Skills (Language) Requirements – Must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, they must be able to speak comfortably and clearly with language motor skills for customers to understand the individual. Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.

Nice To Haves

Experience with Coding (ICD-10)
Authorizations
Call Center setting
Provider Relations, preferably.

Responsibilities

Reinstate home care hours and process DME orders.
Schedule transportation and post-hospitalization appointments (including specialists and CBPCP if needed).
Enter service plans and authorizations for subacute rehab and inpatient stays.
Ensure follow-up appointments are completed; retrieve notes from provider offices.
Process authorization requests received via email or fax and assigns to clinical staff.
Enter and track requests in the documentation system until completion.
Manage inquiries via phone and email promptly.
Prepare and send approval/denial letters within required timeframes.
Participate in team meetings, audits, and staff training.
Identify and report quality-of-care concerns to Quality Management.
Recommend system improvements and assist in resolving care issues.
Train new staff on departmental processes and policies.
Collaborate with internal departments, PACE sites, and network providers for timely issue resolution.
Maintain confidentiality, adhere to HIPAA law and company policies.