Clinical Support Specialist

Job Description

Job Description

Pain Management Clinical Support Specialist

About the Role:

Join Long Island's premier multidisciplinary pain management practice! Groth Pain & Spine is growing fast and looking for a talented, efficient, and knowledgeable Clinical Support Specialist to ensure our patients get timely access to the medications they need. 

Starting as a family practice and growing to become a thriving, multi-location organization with multiple locations in Nassau and Suffolk counties, we strive to provide the highest quality patient care. Our practice consists of knowledgeable, talented and high energy Physicians, APPs, Chiropractors, Physical Therapists, Massage Therapists and Mental Health Professionals who value patient collaboration to create effective and successful treatment plans. With a staff that feels like family, we pride ourselves in creating an environment where you'll enjoy coming to work every day.

We're seeking a positive, enthusiastic, and professional person to join our clinical support team! If you have strong analytical and communication skills, enjoy working collaboratively, and want to make a genuine difference in the lives of patients, don't hesitate to apply!

This is a full time, ON-SITE position in Smithtown, NY.

Minimum Qualifications:

• High school diploma or equivalent; associate degree or higher in a healthcare-related field preferred.
• Experience in healthcare authorization, pharmacy benefit management, and CoverMyMeds.
• Experience navigating Workers' Compensation portals and handling Workers' Compensation authorizations
• Strong knowledge of pain management medications and related clinical guidelines.
• Proficiency in using electronic health records (EHR) and prior authorization software systems.
• Excellent communication skills to interact effectively with healthcare providers and insurance representatives.
• Bilingual English/Spanish (Preferred)

Responsibilities:

• Review and assess prior authorization requests for pain management medications to ensure clinical necessity and compliance with insurance criteria.
• Communicate with healthcare providers to obtain additional information or clarify prescription details as needed for authorization decisions.
• Coordinate with insurance companies and pharmacy benefit managers to facilitate timely approvals and resolve authorization denials or delays.
• Maintain accurate documentation of all authorization activities and decisions in compliance with organizational policies and regulatory requirements.
• Stay current with evolving pain management guidelines, medication formularies, and insurance policies to inform authorization practices.

Skills:

The Care Coordinator utilizes strong analytical skills daily to evaluate medication requests against clinical guidelines and ensuring appropriate authorization decisions. Effective communication skills are essential for liaising with healthcare providers and insurance personnel to gather necessary information and resolve authorization issues promptly. Proficiency with electronic health records and authorization software enables efficient processing and documentation of requests. Attention to detail is critical to maintain compliance with regulatory standards and organizational protocols. 

Why Choose Groth Pain and Spine?

• Competitive pay and comprehensive health coverage
• 401(k) with company match
• Generous PTO
• Real mentorship and promote-from-within culture

If you feel like you meet the criteria above, please don't hesitate to apply! We look forward to hearing from you!

Groth Pain & Spine is an equal opportunity employer.