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Clinical Program Coordinator II in Parsippany at One Call

Date: 10/10/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Parsippany
  • Job Type:
  • Experience:
    Not Specified
  • Date:
    10/10/2018

Job Description

Clinical Program Coordinator II
The Clinical Program Coordinator manages clinical review processes to enable successful completion of reviews and QA audits in a timely manner, and assists in communication of results while maintaining and strengthening professional relationships with internal and external customers.

GENERAL DUTIES & RESPONSIBILITIES:

• Identifies if referral needs clinical review.
• Follows all Insurance Company protocols.
• Obtains all necessary documentation from service provider to complete review.
• Communicates clinical outcomes to external customers.
• Audits and manages review queues and/or reports to ensure timely completion and follow up of reviews
• Assists in audits and updates of incorrect or unknown diagnoses
• Follows up with providers and determine need for review or confirm discharge plans.
• Coordinates escalation of reviews to next level reviewer or MD as needed
• Answers questions from other departments about the Clinical Review process.
• Delivers exceptional customer service with every customer interaction.
• Attends department meetings and participates in training sessions.
• Performs all other duties and assignments as directed by management.
• Meets or exceeds required productivity standards


EDUCATIONAL REQUIREMENTS:

High school diploma or G.E.D.
Prefer experience in clinical office setting 


GENERAL KNOWLEDGE, SKILLS & ABILITIES:

• Ability to effectively present information and respond to questions from colleagues, Adjustors, Nurse Case Managers, Providers and Provider’s office staff.
• Proficient computer skills and data entry.
• Critical thinking and problem solving.
• Manages time and has the ability to multi-task in a fast paced environment.
• Verbal and written communication skills.
• Organizational skills and ability to work with minimal supervision.
• Exceptional customer service.

 PHYSICAL/EMOTIONAL DEMANDS & WORK ENVIRONMENTS:

• For roles located in office or home settings; this job is primarily sedentary and may involve repetitive motions; the employee is regularly required to sit, use hands and fingers, speak, and hear
• For roles located in the field; this job is primarily active; the employee is regularly mobile and must be able to utilize transportation (such as driving), sit, use hands and fingers, speak, and hear
• The employee is occasionally required to stand, walk, and lift objects (up to 10 lbs. weight; up to 4 ft. height)
• Specific vision abilities required by this job include ability to see things from a close distance and ability to adjust focus
• The work environment utilizes florescent lighting; noise level is moderate
• The emotional demand of the job may cause undue stress from, but not limited to, moderate/heavy workload
• Reasonable accommodations will be individually assessed and possibly made to enable individuals with disabilities to perform the essential functions of the position
• Please be advised the job description is subject to change at any time

Clinical Program Coordinator II

Intermediate role. Moderate skills with high level of proficiency. Responds to a high volume of inquiries about One Call Care Management’s products and services. Questions and issues are predominantly routine, but associate must be able to deviate from standard scripts and procedures as needed. Is able to effectively calm upset customers and end a negative situation positively. May coach and share information with professionals with less experience and/or expertise. Works under close to general supervision with little latitude for independent judgment. May consult with senior peers and team leads to learn through experience. Typically requires two or more years of experience in a call center or customer service-related position in a service industry. One or more years of workers compensation experience is preferable. Coordinators are expected to meet or exceed established quality and productivity metrics and handle multiple lines of service.  

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