Clinical Care Coordinator

Job Description

Job Description

Job Title: Clinical Care Coordinator

Job Description

The Clinical Care Coordinator plays a key role in supporting members access to CalAIM Community Supports and related services within a managed care environment. This position focuses on reviewing eligibility, coordinating referrals, processing service authorizations, and maintaining accurate documentation to ensure members receive timely, appropriate care. The role also involves collaborating with internal teams, external providers, and community-based organizations to streamline care coordination processes and uphold regulatory compliance.

Responsibilities

• Review CalAIM Community Supports screening documents to determine member eligibility for CalAIM Community Supports services.
• Follow up with internal staff and providers to support successful referral, enrollment, and retention of members in CalAIM Community Supports services.
• Process daily service authorizations and denials for requested Community Supports services, ensuring accuracy and adherence to established criteria.
• Perform comprehensive data entry, tracking, and case documentation for all referred members, including enrollment status, authorizations, encounter data, care coordination activities, clinical case records, and regulatory reports.
• Support the reconciliation of provider invoicing and claims to ensure consistency between authorizations, services delivered, and payments.
• Send timely communications to Community Supports providers to facilitate on-time submission of required deliverables and reports.
• Assist with the implementation of CalAIM Community Supports trainings for internal teams, external providers, and community-based organizations by providing ongoing education on services, resources, and referral processes.
• Identify gaps and barriers in the care coordination process and help develop solutions to improve member access to services.
• Review provider reports to ensure accurate data collection, documentation, and reporting related to Community Supports and care coordination activities.
• Respond to inquiries from internal and external stakeholders regarding the status of service authorization requests.
• Actively participate in multidisciplinary team meetings to coordinate member care and promote continued engagement in CalAIM Community Supports services.
• Conduct outreach calls to members, as needed, to verify engagement, clarify services, and support continuity of care.
• Participate actively in ensuring that all applicable state and federal rules and regulations are followed in daily operations.
• Perform other related duties as assigned to support utilization management, care coordination, and member services.

Essential Skills

• 24 years of relevant experience in prior authorization, utilization review, utilization management, care coordination, or a closely related function.
• Experience with prior authorization or utilization management, preferably focused on processing authorizations rather than clinical review.
• Referral coordination or referral management experience, preferably in a healthcare, social services, or managed care environment.
• Knowledge of social services and community-based programs, including an understanding of available resources and referral workflows.
• Strong documentation and administrative coordination skills, including tracking cases, service requests, and provider communications with high attention to detail.
• Experience with CalAIM Community Supports, Enhanced Care Management, Medi-Cal, Medicaid, or managed care processes.
• Familiarity with claims processing, invoice reconciliation, and provider relations in a healthcare or managed care setting.
• Understanding of regulatory compliance requirements related to healthcare, Medi-Cal/Medicaid, and managed care operations.
• Community outreach experience, particularly in engaging members and supporting access to services.
• Proficiency with Microsoft Office applications for documentation, reporting, and communication.
• Ability to work remotely in a HIPAA-compliant environment, maintaining confidentiality and data security.
• Residence in California, with the ability to work remotely within the state.
• High school diploma or equivalent.

Additional Skills & Qualifications

• Experience in social services or community resources, with the ability to connect members to appropriate support programs.
• Experience working with Enhanced Care Management and CalAIM Community Supports programs.
• Prior work in a Medicaid or Medi-Cal managed care environment.
• Strong organizational and time management abilities to handle multiple cases, authorizations, and provider interactions simultaneously.
• Effective written and verbal communication skills for collaborating with internal teams, providers, and community-based organizations.
• Comfort with multidisciplinary team collaboration and cross-functional coordination.
• Ability to identify process gaps and contribute to continuous improvement in care coordination workflows.

Work Environment

This is a fully remote position with a Monday through Friday schedule, typically from 8:00 a.m. to 5:00 p.m. The role requires working from a HIPAA-compliant, secure home office environment within the state of California. Work is performed using standard office technologies, including Microsoft Office and systems used for authorizations, claims, and case tracking. The environment is focused on collaborative care coordination, regulatory compliance, and accurate documentation, with regular interaction via phone, email, and virtual meetings. The opportunity offers the potential for extension or transition into a direct role, depending on performance and organizational needs.

This is a Contract position based out of Rancho Cordova, CA.

The pay range for this position is $19.00 - $22.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: Medical, dental & vision Critical Illness, Accident, and Hospital 401(k) Retirement Plan Pre-tax and Roth post-tax contributions available Life Insurance (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA) Transportation benefits Employee Assistance Program Time Off/Leave (PTO, Vacation or Sick Leave)

This is a Contract position based out of Rancho Cordova, CA.

This position is anticipated to close on Nov 16, 2026.

This is a hybrid position in Rancho Cordova,CA.

About Actalent

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The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please email View email address on ziprecruiter.com for other accommodation options.

San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.

Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.

Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.