care coordination specialist

Access: Supports For Living

At Access: Supports for Living and our Access: Network partners, we help people live the healthiest and fullest lives possible - and we support our staff in doing the same. Across our family of organizations, team members work in mental health, substance use, disability, employment, housing, and family services, doing meaningful work in a collaborative and respectful environment. We offer supportive leadership, opportunities to learn and grow, competitive benefits, and the chance to build a career with purpose. If you’re looking for work that matters and a team that values what you bring, the Access Network is a great place to be.
 
Location: Kingston, NY
 Hours: M-F 930 am to 6 pm
 Rate of Pay: $28.85
 
OVERVIEW OF PRIMARY RESPONSIBILITES: 
The position of Care Navigator (CN) is responsible for working closely with individuals to promote effective connection and collaboration to services. Care Navigators are committed to assisting in removing the barriers to care by identifying critical resources, navigating through health care services, insurance plans, and systems. Care Navigators help individuals "navigate" the maze of insurances, administrative systems and support services. They focus on integrating services around the needs of the individual.
 Effective Care Navigators build working relationships, solve problems, direct to resources, and manage information.
 
PRIMARY FUNCTIONS: 
Primary functions include coordination to improve quality of care through the efficient use of resources and thereby enhancing quality, cost-effective outcomes.
 Core Responsibilities
 <ul>
<li>Act as an advocate and assist in coordination of care to minimize the fragmentation of health care delivery systems.</li>
<li>Gather insurance information.</li>
<li>Assist in navigating the complex healthcare and insurance systems.</li>
<li>Assist in securing health insurance.</li>
<li>Assist with completion of paperwork for the sliding scale fee.</li>
<li>Complete referrals to care management services and other internal and external services as needed.</li>
<li>For referrals to care management (internal) follow up with the individual until a warm hand-off to care management is complete.</li>
<li>Identify and effectively utilize community resources to meet the needs of the member/family. Facilitate access to community resources.</li>
<li>Care across the healthcare continuum and optimize clinical and financial outcomes.</li>
<li>Maintain a working knowledge of payer requirements. Negotiate on behalf of the member for cost-effective, high quality services and to maximize the efficient use of resources.</li>
<li>Serve as a liaison to providers, members and families for coordination of services.</li>
<li>Document all interventions using the Complex Care Management billable documentation.</li>
<li>Work collaboratively as part of a team.</li>
</ul>
Community Engagement and Outreach
 <ul>
<li>Routinely engage with members and potential members in community settings, which may include homes, shelters, community centers, and other public locations, to address barriers to care and directly facilitate service access.</li>
<li>Conduct community-based resource identification and networking to establish and maintain strong partnerships with local organizations.</li>
<li>Represent the organization at community health fairs, meetings, and events to promote services and identify individuals needing care navigation support.</li>
<li>Provide safe and reliable transportation for clients to and from appointments, resource centers, and other essential services as required for care coordination.</li>
</ul>
ADDITIONAL FUNCTIONAL / ORGANIZATIONAL SUPPORT: 
<ul>
<li>Build strong working relationships with internal and external partners.</li>
<li>Support organizational priorities through adaptability and process improvement.</li>
<li>Contribute to department goals by maintaining open communication and professional collaboration.</li>
<li>Utilize Electronic Health Records and other systems for accurate and timely documentation.</li>
<li>Participate in staff meetings, trainings, and other organizational development initiatives as required.</li>
</ul>
QUALIFICATIONS AND ATTRIBUTES: 
<ul>
<li>Excellent written, verbal and listening abilities. Communicate appropriately and clearly to staff and providers.</li>
<li>Willingness to establish effective working relationships with internal and external providers / resources. Maintain a good working relationship within the department and with other departments.</li>
<li>Ability to manage conflict, stress and multiple simultaneous work demands in an effective and professional manner.</li>
<li>Ability to work well independently, while collaborating with other team members.</li>
<li>Ability and willingness to self-motivate, to prioritize and change processes to improve effectiveness and efficiency. Adapts to changing program or organizational priorities.</li>
<li>Ability to make independent decisions in accordance with established policies and procedures. Decisions and problem solving require a combination of analysis, evaluation and interpretive thinking.</li>
<li>Knowledge of and appreciation for cultural diversity and low literacy issues in care provision.</li>
<li>Computer literacy. Ability to navigate Electronic Health Records and other systems.</li>
<li>Willingness and ability to travel locally and work in various community settings.</li>
</ul>
EDUCATION AND EXPERIENCE: 
Required (one of the following): 
<ul>
<li>Bachelor's Degree in Health and Human Services or related field (major concentration in social work, psychology, nursing, rehabilitation, education, occupational therapy, physical therapy, recreation or recreation therapy, counseling, community mental health, child and family studies, sociology, speech and hearing or other human services field) or</li>
<li>NYS licensure and registration as a Registered Nurse and a bachelor's degree or</li>
<li>Bachelor's level education or higher in any field with five years of experience working directly with highly vulnerable populations (i.e. those with health, behavioral health, substance use issues), or a Credentialed Alcoholism and Substance Abuse Counselor (CASAC) or equivalent experience in behavioral health, human services or other.</li>
<li>Must possess a valid driver's license and maintain a clean driving record for client transportation purposes.</li>
<li>Bilingual English and Spanish speaking preferred</li>
</ul>
Experience: 
<ul>
<li>Two years of experience in linking individuals with SMI, Developmental Disabilities, or alcoholism or substance abuse to a broad range of services essential to successful living in a community setting</li>
<li>A Master’s degree in a related education field may be substituted for one year of experience.</li>
</ul>
PHYSICAL CHARACTERISTICS: 
These physical demands are representative of the physical requirements necessary for an employee to perform the job's essential functions successfully. Reasonable accommodation can be made to enable people with disabilities to perform the described essential functions of the position, which are reviewed in each case.
 <ul>
<li>Must be capable to access all rooms in a 2-story home</li>
<li>Able to work in open space floor plan</li>
<li>Must be capable to move throughout work day</li>
<li>Occasional lifting of &gt; _25+ pounds</li>
</ul>
An Equal Opportunity Employer, including disability and Veterans
 IND2024

CARE NAVIGATOR - CCBHC URGENT CARE

Methodist Health System

<div>Hours of Work :
40 hours per week
Days Of Week :
Monday - Friday
Work Shift :
Job Description :<div>
Your Job: 
The Care Coordinator will support MMG Primary Care Practices, Physicians, and staff (&ldquo;Patient Care team&rdquo;) in various quality driven projects and act as an extension of the Patient Care team to help MMG achieve quality driven goals. The Care Coordinator participates in planning, providing, and evaluating patient care at the appropriate skill level. The position has a duty to provide a standard of care that meets or exceeds that of a reasonably competent and knowledgeable Medical Assistant. The Care Coordinator works under the direction of the MMG Care Coordination Clinical Manager and in coordination with the Patient Care Team to outreach to patients whose clinical measures need to be addressed. This individual will partner with MMG Primary Care physician offices to help achieve benchmarks for patient care and maintain/improve quality of care delivery across multiple payers and patient populations. 
 
Your Job Requirements: 
 
<ul><li>Graduation from an accredited Medical Assistant program</li><li>Medical Assistant Certification required</li><li>Experience of at least 5 years as a Certified Medical Assistant</li><li>High school graduate or GED equivalent.</li><li>Current Basic Life Support certification.</li><li>Proven ability to mentor others</li><li>Expert in computer literacy in electronic health record.</li><li>Knowledge of medical terminology.</li><li>HEDIS Quality Measures experience</li><li>Excellent communication and customer service skills required</li><li>Proficiency in Word, Excel, and PowerPoint required.</li><li>Ability to work independently, while collaborating with other team members</li><li>Ability to self-motivate, prioritize, and be willing to invest in a change process to improve efficiencies</li></ul> 
Your Job Responsibilities: 
 
<ul><li>Educate and train Patient Care team on standardized operational workflows, developed in coordination with Care Coordination Clinical Manager, to close gaps in care and ultimately optimize quality metrics as measured by various value-based care programs</li><li>Partner with the Patient Care team to assist patients in completing health screens and address preventive care measures that are not yet completed</li><li>Support the Patient Care team as needed by outreaching to Patients with clinical measures needing to be addressed, to either address clinical measures over the telephone or scheduling an office visit for the Patients to address the clinical measures</li><li>Update preventive health screens and clinical measures that have been determined as completed in the EMR, as needed</li><li>Communicate regularly with interdisciplinary team members to coordinate/update a patient&rsquo;s care</li><li>Maintain accurate tracking log of patients who have been outreached and status of their preventive health screens and clinical measures</li><li>Participate in various quality driven initiatives within MMG and collaborate together to achieve high level patient outcomes</li><li>Submit data to external agencies as directed by Care Coordination Clinical Manager</li><li>Explain the importance of preventive health screens and clinical measures to patients and families</li><li>Perform as needed all duties at the expert level within the scope of a Medical Assistant&rsquo;s scope of practice</li><li>Record patient care documentation in the medical record accurately and in a timely manner</li><li>Coordinate patient care as directed by provider, and policies/procedures</li><li>Rotate clinic to clinic within MMG locations as assigned by Care Coordination Clinical Manager</li></ul></div> 
Methodist Health System is a faith-based organization with a mission to improve and save lives through compassionate, quality healthcare. For nearly a century, Dallas-based Methodist Health System has been a trusted choice for health and wellness. Named one of the fastest-growing health systems in America by Modern Healthcare, Methodist has a network of 12 hospitals (through ownership and affiliation) with nationally recognized medical services, such as a Level I Trauma Center, multi-organ transplantation, Level III Neonatal Intensive Care, neurosurgery, robotic surgical programs, oncology, gastroenterology, and orthopedics, among others. Methodist has more than two dozen clinics located throughout the region, renowned teaching programs, innovative research, and a strong commitment to the community. Our reputation as an award-winning employer shows in the distinctions we&rsquo;ve earned:<ul><li>
Great Place to Work Certified 2026-2027</li><li>
Glassdoor&rsquo;s Best Places to Work 2025 &amp; 2026</li><li>
Glassdoor&rsquo;s Best Places to Work in Healthcare, Biotech &amp; Pharma 2026</li><li>
TIME&rsquo;s Best Companies for Future Leaders 2025 &amp; 2026</li><li>
Newsweek&rsquo;s America&rsquo;s Most Admired Workplaces 2026</li><li>
Glassdoor&rsquo;s Best-Led Companies 2025</li><li>
Fortune Best Workplaces in Health Care 2025</li><li>
Military Friendly Gold Employer 2025</li><li>
Becker&rsquo;s Hospital Review 150 Top Places to Work in Healthcare 2025</li><li>
Newsweek&rsquo;s Americas Greatest Workplaces 2025</li></ul></div>

Clinical Care Coordinator

OhioHealth

<div>We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more &ndash; in our careers and in our communities.
Job Description Summary:
The Case Manager extender works collaboratively with all interdisciplinary staff internal to OhioHealth and also external organizations to achieve timely, cost efficient and effective management of patient care. Primary responsibilities include but are not limited to: insurance verification, obtaining pre-authorization and data entry of patient information, triaging phone calls, and directing calls appropriately, status changes, entering initial and correcting inpatient room and bed charges and performing charge reconciliation. The case manager extender is well organized, highly motivated, customer service oriented and expresses good communication skills.
Responsibilities And Duties:
60%
 
ASSURING APPROPRIATE PAYER AUTHORIZATION AND/OR PAYER REQUIREMENTS ARE IN PLACE FOR HOSPITAL PAYMENT. 1. Responsible for insurance verification. When necessary, obtains pre-authorization from insurance companies. Interacts with physician offices and other third parties to obtain all necessary paperwork. 2. Triage incoming calls within the phone processing benchmarks. Answers multi line phone system, screens calls for office/hospital associates, directing to appropriate office/hospital associate, and ensures appropriate phone coverage. 3. Communicate and document accurate and appropriate information to internal and external customers. Communicates with third party payers and sends appropriate clinical information for authorization of hospital stay. 4. Perform authorization data entry and coordination of services through proactive collaboration and communications with utilization management and care coordination team. 5. Monitor commercial payers accounts, to include but not limited to: attachment of requested dictation to claims, addition of diagnosis allowances and authorization numbers 6. Refer utilization management/clinical decisions beyond level of authority to care coordination/UM team and Manager/Director of UM team for review and decision. 7. Provides general office and clerical support for office as assigned by Office Supervisor and or Manager, to include but not limited to: faxing dictation to referring physician offices, completion of disability forms, FMLA forms, Attorney request letters for reports, patient record releases, Industrial C-9s, C-84s, C-86s, Medco 17s, Industrial appeal paperwork and retroactive C-9s. 8. Researching, obtaining and completing required documents for the team. 9. Coordinating ancillary services according to policies 10. Facilitate communication between community agencies, care coordination and utilization management team. 1 1. Facilitates transfers of patients to alternative facilities 12. Attends staff meetings 13. Attends continuing in-house education seminars for further education as needed
 
30%
 
PATIENT STATUS AND CHARGE RECONCILIATION 1. Responsibility for updating/correcting patient status for appropriate claim drop. 2. Perform charge entry to match appropriate patient status. 3. Review the charge reconciliation report daily to ensure that all room and bed charges are entered correctly on a patient. 4. Work in conjunction with the clinical, revenue and observation billers to correct or adjust any claims as directed by payer discussions.
 
10%
 
ORGANIZATIONAL/OFFICE RESPONSIBILITIES 1. Sorts, distributes, and mails transcription as assigned 2. Orders and stocks office supplies. 3. Ensure office equipment, are clean and well-maintained. 4. Provides support to appropriate staff members as assigned 
 
 
 
As a High Reliability Organization (HRO), responsibilities require focus on safety, quality and efficiency in performing job duties.
 
 
The job profile provides an overview of responsibilities and duties and is not intended to be an exhaustive list and is subject to change at any time
Minimum Qualifications:
High School or GED (Required)
Additional Job Description:
Associates degree, or three to five years related Experience and/or training, or equivalent combination of and Experience . Computer competency in Microsoft Word, Excel, and Outlook, with a strong aptitude to learn other programs as needed. Ability to manage multiple priorities.
Work Shift:
Day
Scheduled Weekly Hours :
As Needed
Department
UM Care Coord-North Hub
Join us!
 
... if your passion is to work in a caring environment
 
... if you believe that learning is a life-long process
 
... if you strive for excellence and want to be among the best in the healthcare industry
Equal Employment Opportunity
OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment</div>

Case Manager Extender - Part-time Casual - Mansfield Hospital

AdventHealth Lake Wales

<div>Our promise to you:
Joining AdventHealth is about being part of something bigger. It&rsquo;s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
All the benefits and perks you need for you and your family:<ul><li>
Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance</li><li>
Paid Time Off from Day One</li><li>
403-B Retirement Plan</li><li>
4 Weeks 100% Paid Parental Leave</li><li>
Career Development</li><li>
Whole Person Well-being Resources</li><li>
Mental Health Resources and Support</li><li>
Pet Benefits</li></ul>
Schedule:
Full time
Shift:
Day (United States of America)
Address:
410 S 11TH ST
City:
LAKE WALES
State:
Florida
Postal Code:
33853
Job Description:
Up to $5K Sign on Bonus (if eligible)
Up to $10K Relocation (if eligible)
Provides grief counseling, disease adjustment support, crisis intervention, goals of care planning support, and de-escalation services for patients as appropriate.<ul><li>Assesses patients&rsquo; and families&rsquo; wholistically for discharge planning needs in the inpatient, observation and/or emergency departments, including prior functioning, support systems, financial, and psychosocial in a timely fashion to avoid delays in discharge planning.</li><li>Reviews the medical record, including medications, history and physical, labs, and progress notes and incorporates the clinical, social, and financial factors into the transition of care plan.</li><li>Develops discharge plans with appropriate contingency plans throughout the hospital stay to ensure timely care coordination and progression of care, making arrangements for post-acute care services and facilities as well as community care for social needs.</li><li>Leverages technology and follows standard work and best practices to communicate with post-acute care services and facilities to ensure patient care information is communicated for continuity of care, medical records are complete, and discharge reconciliation is accurate.</li></ul>
&bull; Actively participates in multi-disciplinary rounds to review changes in patient status, progression and level of care, and discharge plans for all assigned patients to identify resources necessary at discharge and ensure a timely transition, escalating care delays to leadership as appropriate. &bull;Communicates with and educates patients and families regarding emotional, social, and financial impacts of illness and mobilizes family/community resources to meet identified needs while advocating for patient and family empowerment in making health care decisions and accessing needed services.
&bull; Organizes and facilitates patient and family care conferences with the multidisciplinary team. &bull;Documents discharge planning evaluation, ongoing assessment, discharge plans, MDRs, barriers to progression of care, avoidable days, and patient and family needs according to standard work. &bull;Provides patient and family advocacy, and support patient&rsquo;s choice and patient rights during hospitalization.<ul><li>Communicates with Payors patient&rsquo;s needs for authorization for post-acute care as needed.</li><li>Assesses readmitted patients for the patient&rsquo;s and family&rsquo;s perceived reasons for the readmission.</li><li>Other duties as assigned.</li></ul><div>
Knowledge, Skills, and Abilities: 
<ul><li>Excellent interpersonal communication and negotiation skills [Required</li><li>Critical thinking and problem-solving skills [Required]</li><li>Psychosocial assessment skills [Required]</li><li>Customer service skills [Required]</li></ul></div><ul><li>Ability to work and communicate with people of all social, economic, and cultural backgrounds; be flexible, open-minded and adaptable to change [Required]</li><li>Effective organizational skills [Required]</li><li>Computer proficiency with Outlook e-mail and electronic medical records [Required]</li><li>Flexible in a complex and changing healthcare environment [Required]</li><li>Understanding of pre-acute and post-acute venues of care and post-acute community resources [Required]</li><li>Maintains a current working knowledge of services available in the local community, particularly services available to patients with limited or non-existent payment resources [Required]</li><li>Strong interview, assessment, and organizational skills [Required]</li><li>Leadership skills [Required]</li><li>Data analysis skills [Required]</li><li>Current working knowledge of discharge planning, utilization management, care management, performance improvement and managed care reimbursement [Preferred]</li><li>Knowledge of state and federal guidelines pertinent to Care Management [Preferred]</li><li>Ability to identify appropriate community resources and to work collaboratively with patients, families, multidisciplinary team and community agencies to achieve desired patient outcomes [Preferred]</li><li>Knowledge of state and federal guidelines pertinent to care management [Preferred]</li></ul><div> 
Education: 
<ul><li>Master's [Required]</li></ul> 

Field of Study: 
<ul><li>N/A</li></ul> 

Work Experience: 
<ul><li>2+ care management experience [Preferred]</li><li>2+ social work [Required]</li></ul> 

Additional Information: 
Additional Licensure or certification requirements may apply depending on the specific unit or state in which this position is located. Please consult the relevant credential grid for detailed information regarding these requirements 
 
Licenses and Certifications: 
<ul><li>Accredited Case Manager (ACM) [Preferred]</li><li>Certified Case Manager (CCM) [Preferred]</li></ul> 

Physical Requirements: (Please click the link below to view work requirements) 
Physical Requirements - https://tinyurl.com/msy4mja2</div>
Pay Range:
$22.88 - $42.54
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.</div>

Care Management Social Worker Nonexempt

Optum

<div>Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. You also must be able to work a flexible schedule that includes evening hours. This is high volume, customer service environment. You'll need to be efficient, productive and thorough working with paper and electronic medical records.
Hours/Location: Monday-Friday 8am-5pm. You'll enjoy the flexibility to work hybrid role at 19191 VERMONT AVE TORRANCE, CA
Primary Responsibilities:<ul><li>
Manage the intake of members or the admission/discharge information post notification</li><li>
Work with hospitals, clinics, facilities and the clinical team to manage requests for services from members and/or providers</li><li>
Manage the referral process, processing incoming and outgoing referrals and prior authorizations, including intake, notification and census roles</li><li>
Provide appropriate triage and care coordination notification cases for non-clinical assessment/intervention</li><li>
 Handle resolution/inquiries from members and/or providers Handle resolution/inquiries from members and/or providers This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. You also must be able to work a flexible schedule that includes evening hours.</li></ul>
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:<ul><li>
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays</li><li>
Medical Plan options along with participation in a Health Spending Account or a Health Saving account</li><li>
Dental, Vision, Life&amp; AD&amp;D Insurance along with Short-term disability and Long-Term Disability coverage</li><li>
401(k) Savings Plan, Employee Stock Purchase Plan</li><li>
Education Reimbursement</li><li>
Employee Discounts</li><li>
Employee Assistance Program</li><li>
Employee Referral Bonus Program</li><li>
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)</li></ul>
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:<ul><li>
High School Diploma/GED (or higher)</li><li>
1+ years of customer service experience</li><li>
Basic level of experience with MS Word, Excel and Outlook</li></ul>
Preferred Qualifications:<ul><li>
Experience doing patient outreach</li><li>
Bilingual (English/Spanish)</li><li>All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.</li></ul> 
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16.15 to $28.80 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. 
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. 
#RPO #YELLOW</div>

Associate Clinical Admin Coordinator

Blue Shield of California

<div>
 
 Job Description
 
 
 
 
 Your Role
 
 
 
 The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator, Entry will report to the Supervisor of the HEDIS Outreach Team. In this role you will be responsible for conducting provider outreach during the HEDIS season for medical record pursuit and retrieval. Also, participation in Quality initiatives involving member outreach for care gap closure. Responsible for maintaining high productivity and standard work.
 
 
 Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow &ndash; personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
 
 
 
 Responsibilities
 
 
 
 
 Your Work
 
 
 
 
 In this role, you will:
 
 
 
 <ul>
 <li>
 Initiate outbound calls to members and providers to collect information and provide care coordination assistance in obtaining services (schedule appointments, provider appointment reminders, coordinate transportation, etc.)
 </li>
 <li>
 Educate members on missing care gaps and provide encouragement to obtain missing service.
 </li>
 <li>
 Request medical records from PCP/Specialists by fax, remote EMR access or scheduled site visits as needed
 </li>
 <li>
 Manage and maintain HEDIS files and medical records
 </li>
 <li>
 Provide administrative support, including generating correspondence, organize mass mailings, coordinator schedules and training
 </li>
 <li>
 Continued development of understanding of HEDIS hybrid measures and medical record requirements for HEDIS compliance
 </li>
 <li>
 Research member claims and encounters to identify accurate pursuit information for medical record retrieval
 </li>
 <li>
 Review medical records and identify elements for compliance
 </li>
 <li>
 Create and maintain detailed logs of member and provider interactions
 </li>
 <li>
 Ability to de-escalate situations
 </li>
 <li>
 Assist in onboarding contingent workforce for HEDIS and outreach projects
 </li>
 <li>
 EMR and vendor portal medical record retrieval
 </li>
 <li>
 Developing understanding of HEDIS pursuit processes relative to pursuit systems and tracking processes
 </li>
 <li>
 Developing understanding of outreach and pursuit project intake procedures, schedules, and reporting requirements
 </li>
 <li>
 Ability to work independently in a fast-paced environment with minimal errors
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 
 Your Knowledge and Experience
 
 
 
 <ul>
 <li>
 Requires a high school diploma or equivalent
 </li>
 <li>
 Requires limited knowledge of systems and procedures
 </li>
 <li>
 Typically, has limited or no prior experience
 </li>
 <li>
 Communication and interpersonal skills
 </li>
 <li>
 Must be organized with the ability to keep accurate notes and records
 </li>
 <li>
 Customer service experience is preferred
 </li>
 <li>
 HEDIS knowledge strongly preferred
 </li>
 <li>
 Critical thinking skills
 </li>
 <li>
 Knowledge of computer applications including Microsoft Word, PowerPoint and Excel. Internet knowledge with the ability to complete searches
 
 
 </li>
 </ul>
 
 Hybrid Virtual Work
 
 
 
 This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.
 
 
 
 About The Team
 
 
 
 
 About Blue Shield of California
 
 
 
 As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
 
 
 At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
 
 
 To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
 
 
 Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities &ndash; join us!
 
 
 
 Our Values:
 
 
 
 <ul>
 <li>
 Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
 </li>
 <li>
 Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
 </li>
 <li>
 Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
 
 
 </li>
 </ul>
 
 Our Workplace Model
 
 
 
 We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
 
 
 <ul>
 <li>
 For most teams, this means coming into the office two days per week.
 </li>
 <li>
 Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
 </li>
 <li>
 For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
 
 
 </li>
 </ul>
 The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
 
 
 
 Physical Requirements:
 
 
 
 Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
 
 
 Please click here for further physical requirement detail.
 
 
 
 Equal Employment Opportunity:
 
 
 
 External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
</div>

Clinical Quality Coordinator, Entry

<div>Your Role 
 
The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator, Entry will report to the Supervisor of the HEDIS Outreach Team. In this role you will be responsible for conducting provider outreach during the HEDIS season for medical record pursuit and retrieval. Also, participation in Quality initiatives involving member outreach for care gap closure. Responsible for maintaining high productivity and standard work. 
 
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow &ndash; personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.</div>
 <div>Your Work
In this role, you will:
<ul><li>Initiate outbound calls to members and providers to collect information and provide care coordination assistance in obtaining services (schedule appointments, provider appointment reminders, coordinate transportation, etc.)
</li><li>Educate members on missing care gaps and provide encouragement to obtain missing service.
</li><li>Request medical records from PCP/Specialists by fax, remote EMR access or scheduled site visits as needed
</li><li>Manage and maintain HEDIS files and medical records
</li><li>Provide administrative support, including generating correspondence, organize mass mailings, coordinator schedules and training
</li><li>Continued development of understanding of HEDIS hybrid measures and medical record requirements for HEDIS compliance
</li><li>Research member claims and encounters to identify accurate pursuit information for medical record retrieval
</li><li>Review medical records and identify elements for compliance
</li><li>Create and maintain detailed logs of member and provider interactions
</li><li>Ability to de-escalate situations
</li><li>Assist in onboarding contingent workforce for HEDIS and outreach projects
</li><li>EMR and vendor portal medical record retrieval
</li><li>Developing understanding of HEDIS pursuit processes relative to pursuit systems and tracking processes
</li><li>Developing understanding of outreach and pursuit project intake procedures, schedules, and reporting requirements
</li><li>Ability to work independently in a fast-paced environment with minimal errors</li></ul></div>
 <div>Your Knowledge and Experience
<ul><li>Requires a high school diploma or equivalent
</li><li>Requires limited knowledge of systems and procedures
</li><li>Typically, has limited or no prior experience
</li><li>Communication and interpersonal skills
</li><li>Must be organized with the ability to keep accurate notes and records
</li><li>Customer service experience is preferred
</li><li>HEDIS knowledge strongly preferred
</li><li>Critical thinking skills
</li>Knowledge of computer applications including Microsoft Word, PowerPoint and Excel. Internet knowledge with the ability to complete searches 
<li>
</li></ul>Hybrid Virtual Work
 
This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.</div>
 <div>ABOUT THE TEAM 
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities &ndash; join us!
Our Values:
<ul><li>Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
</li><li>Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
</li><li>Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
</li></ul><div>Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
<ul><li>For most teams, this means coming into the office two days per week.
</li><li>Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
</li><li>For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
</li></ul>The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
</div>Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day. 
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.</div>

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