Commonwealth Care Alliance is a nonprofit organization providing integrated health care and social support services to people with complex medical needs. We have openings for individuals who want to be part of a committed and collaborative interdisciplinary clinical operations team providing high quality service to individuals with complex medical needs.
Under the guidance of the Clinical Decision Support Team (CDST) Supervisor, this role is responsible to provide administrative support and guidance around clinical decision support tools and activities conducted by Commonwealth Care Alliances Primary Care, Interdisciplinary Care and Clinical Operations staff.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Assist with the collection of structured clinical data for completion of service decision request; asking scripted clinical and/or community based supports and services questions, accepting responses to scripted clinical questions, entering data, managing and processing the authorization
- Coordinate with the clinical teams to conduct non ] clinical medical management activities: reviewing submissions for completeness and accuracy, and submitting for payment adjudication
- Identify requests requiring clinical expertise/community supports review and appropriately refer those cases to the licensed CDST staff or supervisor
- Provide clear and accurate documentation of all communication and activities
- Handle all requests timely and accurately according to Clinical Operations Department standards
- Support the CDST in other administrative responsibilities as appropriate
- High school diploma required; Associates degree preferred
- Strong community based service and supports and /or medical terminology skills
- Previous experience, community based services and supports, referral management, call center or physician practice preferred
- Strong interpersonal, verbal and written communication skills
- Ability to work well in a team model
Commonwealth Care Alliance - 15 months ago