Clinical Resource Coordinator

Ohio County Healthcare•Hartford, KY

7d•Onsite

About The Position

The Clinical Resource Coordinator supports clinical operations by managing resources, coordinating patient care activities, staying up to date and managing HMO plan requirements, and ensuring efficient workflow across specialty services or clinic areas. This role serves as a liaison between providers, clinical staff, and support departments to ensure compliance with payer contracts and referral auth management.

Requirements

Minimum high school diploma or equivalent required for all positions (may be allowed to sign a GED agreement to obtain within 6 months).
Clinical background (CMA, LPN, RN, or similar)
Experience in ambulatory care, specialty clinics, or hospital setting
Strong organizational and multitasking skills
Knowledge of clinical workflows and healthcare operations
Excellent communication and interpersonal skills
Ability to problem-solve and adapt in a fast-paced environment
Experience with managed care/HMO plans
Working knowledge of EHR systems
Strong attention to detail and data entry accuracy

Nice To Haves

Associate or bachelor’s degree in healthcare-related field

Responsibilities

Coordinate scheduling and assist with urgent IDN (Individual Determination Notifications)
Support providers and clinical teams in managing patient flow and care delivery
Assist with coordination of specialty services, referrals, and follow-up care
Serve as the central liaison between providers and clinical staff
Ensure or assist in completion of referral prior authorizations with appropriate clinical documentation
Facilitate communication between patients, providers, and care teams
Assist with care coordination for complex or high-risk patients
Ensure timely completion of clinical documentation and referral submissions
Ensure patient verification is complete and payer requirements are confirmed
Assist in resolving discrepancies in referral documentation also helping to appeal denied authorizations
Identify workflow inefficiencies and recommend/implement improvements
Assist leadership with tracking performance metrics and operational goals
Provide routine reports for leadership
Track and report key metrics such as number of authorized visits and monitor the 6- month authorization requirement providing clinical documentation to support ongoing need (alongside provider)
Aid in correcting and resubmitting referrals or authorizations as needed
Work closely alongside the leadership of patient financial services to ensure and train staff on understanding HMO plans and requirements along with the importance or accurate insurance information within the system.
Ensure adherence to payer changes and updates
Maintain accuracy of documentation and data reporting
Ongoing monitoring of referral process for additional information requests, denials, and delays
Constant communication with all provider practice clinics and key departments to provide updates, routine refresher training and explain gaps within the process
Random and scheduled audits in all areas to ensure compliance and answer questions or provide support