Clinical Coordinator

• Provide timely medical reviews and clinical determinations based on evidence-based criteria and authorization guidelines
• Conduct daily, weekly, and quarterly reporting in coordination with client service-level agreements
• Outreach to and educate providers to obtain required authorization documentation
• Coordinate and schedule peer-to-peer reviews and appeal appointments between physicians
• Track and record quarterly compensation/reimbursement
• Coordinate with Independent Review Organizations to ensure timely appeals processing and audit utilization case management for specific states
• Organize and present quarterly and annual audits
• Process incoming and outgoing correspondence and faxes within required standards and timelines
• Manage multi-step workflows and delegate tasks to the appropriate workstream
• Communicate and escalate potential enhancements to internal and external processes
• Categorize documentation in accordance with PHI/HIPAA restrictions
• Serve as backup for the utilization associate

Utilization Management Clinical Coordinator

• Draft clinical criteria policies and question sets for medications requiring prior authorization using FDA labeling, clinical guidelines, and drug compendia
• Perform initial quality checks for clinical accuracy and guideline alignment
• Identify medications needing new or updated criteria using dashboards and reporting
• Submit criteria for pharmacist and policy committee review and approval
• Prepare summary materials and supporting documentation for policy committee review
• Maintain the master criteria tracking log in Confluence, including approvals, effective dates, review dates, and version history
• Build approved criteria and question sets in the prior authorization platform
• Develop and execute test cases for question logic, branching, and outcomes
• Migrate approved and tested policies to production and maintain version control
• Build and maintain prior authorization forms and correspondence templates
• Research and incorporate state-specific prior authorization requirements under Compliance guidance
• Maintain reference logs of state-specific requirements by state and client/plan
• Implement compliant member notifications for approvals, denials, and appeal rights
• Steward the Confluence criteria repository and archive retired or superseded criteria
• Create and update job aids for the Prior Authorization Coordinator Team
• Communicate criteria updates and workflow changes to internal teams and stakeholders
• Serve as a subject matter resource on criteria application
• Support client, URAC/NCQA, and state regulatory audits
• Audit criteria effective dates and alignment with plan parameters
• Assist with appeals or grievance reviews by providing criteria documentation and rationale
• Manage expedited criteria development for urgent situations
• Perform other duties as assigned

Prior Authorization Clinical Criteria – Policy Coordinator

• Coordinate care for patients with end-stage renal disease (ESRD) and chronic kidney disease
• Track labs, vital signs, weight, and clinical outcomes
• Supervise and support Patient Care Technicians (PCTs)
• Deliver dialysis care in compliance with clinical and regulatory standards
• Train and mentor clinical staff
• Float between Penn State Holy Spirit, Select Specialty Camp Hill, and UPMC Carlisle facilities as needed
• Work a flexible schedule, including mornings, evenings, weekends, and holidays
• Lead inpatient dialysis care and coordinate the clinical team in a hospital setting

Clinical Coordinator – RN Supervisor

• Oversee all operations and activities of a smaller-sized dialysis unit
• Ensure quality measures and safe dialysis treatments are delivered
• Develop, train, coach, and act as a resource for clinical teammates
• Coordinate activities with technical personnel
• Maintain relationships and communication with providers, DOC/BOP, managed healthcare organizations, post-acute facilities, hospitals, and clients
• Manage inventory, supplies, staffing efficiencies, and regulatory compliance
• Lead the unit in compliance with HIPAA, OSHA, ESRD, state and federal regulations, and company policies
• Schedule and assign staff to maintain appropriate patient-to-staffing ratios
• Manage PTO requests, overtime, census-related staffing, and PRN staffing
• Facilitate staff development, training, monthly education, onboarding, and skills checks
• Ensure clinical teammates maintain current licenses and certifications
• Deliver safe and effective patient care across treatment modalities
• Model accurate documentation and participate in patient education
• Manage lab collections, quality control, patient care reviews, and monthly facility audits
• Develop action plans for deficiencies and support CQI/QAPI initiatives
• Act as liaison to the corporate biomedical team and submit service requests
• Maintain unit safety, cleanliness, infection control, and protected health information
• Supervise medical records and ensure complete documentation
• Maintain communication with facility personnel, managed care groups, providers, management, biomedical teams, and staff
• Record attendance and assist with payroll and timesheet processes in ADP
• Review and submit treatment rosters within two days of month end
• Submit supply orders and maintain adequate, unexpired inventory and emergency supplies
• Identify dialysis business development opportunities and refer leads
• Report incidents and work-related injuries
• Report to the Regional Director and supervise clinical team members

Dialysis Clinical Coordinator, RN

• Oversee overall operations and activities of a smaller-sized dialysis unit
• Use clinical/nursing knowledge and dialysis experience to ensure quality measures and safe dialysis treatments
• Develop, train, coach, act as a resource for, and oversee clinical teammates
• Coordinate activities with technical personnel
• Maintain strong relationships and communication with providers, DOC/BOP, managed healthcare organizations, post-acute facilities, hospitals, and clients
• Manage inventory, supplies, staffing efficiencies, and compliance with company and state regulatory requirements
• Report to the Regional Director and supervise clinical team members
• Ensure compliance with HIPAA, OSHA, ESRD, state and federal regulations, and company policies
• Lead, coach, guide, delegate tasks, hold team huddles, and deliver corporate communications
• Participate in onboarding, training, education, in-servicing, skills checks, interviews, and candidate selection as required
• Manage staff scheduling, assignments, PTO requests, overtime, patient-to-staffing ratios, and PRN staffing
• Deliver safe and effective patient care across treatment modalities
• Model accurate documentation and participate in patient education
• Manage lab collections, quality control measures, patient care review meetings, facility audits, and corrective action plans
• Act as on-site liaison to the corporate biomedical team and submit service requests
• Maintain unit safety, cleanliness, infection control, protected health information, medical records, and regulatory compliance
• Collaborate on CQI/QAPI initiatives, clinical goals, and patient outcomes
• Maintain communication with facility personnel, managed care groups, providers, management, biomedical teams, and staff
• Record and review payroll and timesheets in ADP
• Review and submit treatment rosters within two days of month end
• Submit supply orders and maintain adequate, unexpired emergency inventories
• Develop client partnerships and identify potential business opportunities
• Promote the company mission, vision, and core values
• Report incidents and work-related injuries and follow company policies and procedures
• Maintain regular, predictable attendance and punctuality
• Perform other duties as assigned

• Provide non-clinical administrative support to clinical teams
• Coordinate patient care activities in a timely, accurate, and efficient manner
• Partner with nurses, pharmacists, providers, and internal business partners
• Manage administrative workflows and maintain patient records
• Coordinate documentation and support therapy-related processes
• Deliver exceptional customer service
• Ensure compliance with company policies, regulatory requirements, and quality standards
• Support operational efficiency and positive patient outcomes
• Manage multiple priorities in a fast-paced environment

Clinical Support Coordinator, Specialty Nursing

• Coordinate care for ESRD patients, including tracking labs, vital signs, weight, and clinical outcomes
• Supervise and support a team of Patient Care Technicians (PCTs)
• Deliver high-quality dialysis care in compliance with clinical and regulatory standards
• Train and mentor clinical staff
• Float between facilities as needed
• Work mornings, evenings, weekends, and holidays as required
• Provide critical, life-sustaining care in a hospital setting

• Coordinate admissions with the admissions department and facility
• Support patients and their support systems through onsite assessments and admission
• Schedule admission times, tours, assessments, and coordinate the intake process
• Oversee patient intake, complete initial assessments, paperwork, and send information to the home office
• Guide patients through pre-admission medical standard procedures as needed
• Provide preliminary diagnoses and communicate them to assigned therapists and registered dietitians
• Support patients and support systems during their first week and conduct check-in calls
• Contact referring and outpatient treatment team members upon admission when releases are available
• Conduct in-person pre-admission assessments and recommend level of care based on APA Guidelines and Discovery admissions criteria
• Conduct program tours
• Facilitate groups and provide meal support
• Help manage the milieu and oversee patient activities and interactions
• Educate patients about admission processes and treatment; review patient rights and expectations
• Maintain confidentiality of outpatient programming and related activities
• Travel to other facilities for training or assistance when needed
• Support local programs as requested by leadership

• Develop, staff, market, organize, and manage services
• Provide counseling using evidence-based methodologies, including individual, group, and family therapy
• Provide clinical supervision and consultation to substance use clinicians and interns/practicum students
• Train or ensure training of new staff, interns, and practicum students
• Ensure substance use clinical services are recovery focused and trauma informed
• Collaborate across nursing, substance abuse outpatient treatment, and residential treatment programs
• Ensure assigned staff meet specialty annual requirements
• Conduct intakes, assessments, and write assessment summaries
• Link service recipients with internal and external resources
• Maintain contact and consultation with referral sources
• Assist with discharge planning and provide follow-up services
• Monitor urinalysis, breathalyzer, and other testing
• Make decisions to assure program continuity in the supervisor’s absence

• Act as liaison for statewide appeals, fair hearings, review organizations, and other external appeals
• Ensure appeal letters comply with State and NCQA requirements
• Review clinical information for appeals using nationally recognized criteria to determine medical necessity
• Prepare reviews for cases that do not meet criteria
• Gather, analyze, and report information regarding member and provider clinical appeals, including follow-up
• Prepare response letters for member and provider clinical appeals
• Maintain files and logs for all appeals
• Coordinate with Medical Directors to clarify medical determinations or clinical rationale
• Maintain current knowledge of NCQA and State regulations
• Coordinate Fair Hearings with internal departments and agencies
• Perform other assigned duties and comply with policies and standards

Clinical Coordinator jobs in United States

Utilization Management Clinical Coordinator

Prior Authorization Clinical Criteria – Policy Coordinator

Clinical Coordinator – RN Supervisor

Dialysis Clinical Coordinator, RN

Dialysis Clinical Coordinator, RN

Clinical Support Coordinator, Specialty Nursing