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Clinical Program Coordinator in Jacksonville, FL at One Call

Date: 8/4/2018

Job Snapshot

Job Description

Clinical Program Coordinator
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 standard

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 I

Entry level role. Basic skills with moderate level of proficiency. Generally performs a high volume of basic clinical program coordination and handles inquiries about One Call’s clinical programs following standard scripts and procedures. Works under close supervision without latitude for independent judgment. Consults with senior peers and team leads on non-complex issues to learn through experience. Typically requires zero to one year of experience in a call center or customer service-related position in a service industry. Zero- 2 years of experience in the workers compensation industry. 

EEO Employer


841 Prudential Dr, Suite 204
Jacksonville, Florida, 32207
United States