Nursing, Pharmacy, & Health Services - Clinical Support Coordinator 2

Title: Clinical Support Coordinator 2 Community Supports / Referral & Authorization



Location: Remote CA



Duration: 3 Months (Possible Extensions)



Shift: 8AM 5PM PST



Pay: $23.00 - $25.00 Per hr. on w2.

Position Overview

We are seeking a Clinical Support Coordinator 2 to support Community Supports services within a healthcare environment. This role will focus on CalAIM Community Supports referrals, member eligibility, service authorizations, utilization management activities, care coordination, documentation, and provider communication .

The ideal candidate will have experience working with a medical population , particularly in utilization management, utilization review, medical review, prior authorization, referral processing, or healthcare coordination . Strong organizational skills, attention to detail, confidentiality, communication, and proficiency with Microsoft Office-especially Excel -are required.

Key Responsibilities

Community Supports & Referral Management

• Review CalAIM Community Supports screening documents to determine member eligibility for Community Supports services.
• Review referrals received for Community Supports services against established eligibility criteria.
• Verify member eligibility before processing referrals and authorizations.
• Follow up with internal staff and providers to support successful referral and enrollment of members into Community Supports services.
• Identify and help address gaps and barriers in the care coordination process to improve member access to services.
• Conduct outreach calls to members, as needed, to verify engagement in Community Supports services.

Authorization & Utilization Management

• Process daily service authorizations and denials for requested Community Supports services.
• Perform authorization review and utilization management activities in accordance with applicable criteria.
• Respond to inquiries regarding the status of service authorization requests.
• Ensure referrals and authorization activities are processed accurately and timely.
• Support appropriate member access to authorized services.

Documentation, Data & Reporting

• Perform accurate data entry, tracking, and case documentation for members referred for services.
• Maintain records related to:
  • Enrollment status
  • Service authorizations
  • Encounter data
  • Care coordination activities
  • Clinical case records
  • Regulatory reports
• Review provider reports to ensure accurate data collection and reporting.
• Support reconciliation of provider invoicing and claims.
• Maintain organized and confidential member information.

Provider & Internal Coordination

• Communicate with Community Supports providers regarding deliverables, reports, referrals, and authorization status.
• Support timely submission of required provider documentation and reports.
• Participate in Multidisciplinary Team (MDT) meetings to coordinate member care and support member retention in Community Supports services.
• Support implementation of CalAIM Community Supports training for internal teams, external providers, and community-based organizations.
• Provide ongoing education regarding Community Supports services and the referral process.
• Work collaboratively with internal teams, providers, and community-based organizations.

Compliance & Customer Support

• Follow applicable state and federal rules, regulations, policies, and procedures.
• Maintain confidentiality of member and healthcare information.
• Provide professional customer service and respond appropriately to inquiries.
• Perform other duties and assignments as required.

Required Qualifications

• High school diploma or GED required.
• 2 4 years of relevant professional experience required.
• Experience working with a medical/healthcare population .
• Experience with utilization management, utilization review, medical review, authorization, prior authorization, or referral processing .
• Experience reviewing referrals and determining eligibility.
• Experience processing or reviewing healthcare service authorizations.
• Strong verbal and written communication skills.
• Strong organizational and multitasking abilities.
• Ability to work independently and manage time effectively.
• Strong attention to detail.
• Ability to maintain confidential information.
• Proficiency with Microsoft Excel, Word, and PowerPoint .
• Comfortable working with healthcare applications and systems.
• Ability to quickly learn new systems, processes, and workflows.
• Must be located in California.
• Must be available to work 8:00 AM 5:00 PM PST, Monday through Friday .

Preferred Skills

• Experience with CareConnect .
• CalAIM experience.
• Community Supports experience.
• Healthcare referral management.
• Prior authorization experience.
• Utilization management/utilization review experience.
• Experience with medical claims or provider invoicing.
• Experience working with multidisciplinary care teams.
• Experience communicating with healthcare providers or community-based organizations.

Top Must-Have Skills

1. Utilization Management / Authorization Review
2. Medical Population / Healthcare Experience
3. Referral & Eligibility Review
4. Microsoft Excel & Healthcare Systems
5. California Residency
6. Availability for 8:00 AM 5:00 PM PST