Clinical Coordinator

GENERAL DESCRIPTION

Responsible for managing administrative tasks, coordinating services, and maintaining compliance with established protocols. Serves as a vital link between members, healthcare providers, and the multidisciplinary team within the organization. Facilitates the delivery of services to members in an integrated and timely manner, ensuring streamlined communication and operational efficiency among various departments and stakeholders. Regular (Non‑Exempt)

ESSENTIAL FUNCTIONS

Provides comprehensive administrative support related to unit operations, including drafting and sending communication (letters, reports, and presentations), coordinating meetings, and managing requests for equipment and materials. Collaborates with team members to prepare presentations, reports, graphs, and other essential documentation while ensuring timely follow‑up on pending information with other departments, such as eligibility, benefits verification, and payment agreements. Facilitates effective communication by receiving and making phone calls to members and health service providers. Accurately transfer calls to the clinical team and other relevant departments, as necessary. Contacts members proactively to gather current provider information, ensuring that all data is up to date and accurate. Assesses incoming service requests for compliance with criteria and departmental guidelines, facilitating the timely authorization of services as needed. Completes and submits requests through operational platforms to the appropriate departments, ensuring adherence to established protocols. Verifies, channels, and maintains follow‑up on pending services and cases with the relevant areas.Communicates final determinations to members and providers within established timeframes, adhering to the department's policies and procedures. Organizes and maintains document filing systems in compliance with HIPAA requirements, ensuring confidentiality and security of sensitive information. Maintains accurate and detailed reports to meet established productivity metrics, quality standards, and regulatory requirements. Coordinates with hospital representatives or medical groups (IPAs) to monitor and facilitate the delivery of services to members. Identifies and refers any issues or situations encountered during daily responsibilities to the supervisor or manager for further evaluation and guidance. Serves as a point of contact for representatives from healthcare facilities, ensuring effective communication and resolution of issues. Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices. May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS

Education and Experience Bachelor’s degree in Business Administration or related fields. At least six (6) months of previous experience in healthcare settings, particularly in clinical or administrative roles, is preferred. Associate’s degree in Business Administration, or related fields, and/or at least sixty to sixty‑four (60-64) approved university credits equivalent to two (2) years of studies. At least one (1) year of previous experience in healthcare settings, particularly in clinical or administrative roles, is preferred. High School Diploma or Technical Course. At least two (2) years of previous experience in healthcare settings, particularly in clinical or administrative roles, is preferred. “Proven experience may be replaced by previously established requirements.” Certifications / Licenses: N/A Other: N/A

LANGUAGES

Spanish – Basic (comprehensive, writing, and verbal) English – Basic (comprehensive, writing, and verbal) We are an Equal Employment Opportunity Employer and take affirmative action to recruit Protected Veterans and Individuals with Disabilities. #J-18808-Ljbffr MCS Puerto Rico