Care Services Coordinator Jobs

Company Overview

Clear Spring Health is part of Group One Thousand One (“Group1001”), a customer-centric insurance group whose mission is to make insurance more useful, intuitive and accessible so that everyone feels empowered to achieve financial security. Clear Spring Health is dedicated to helping seniors protect their health and well-being by providing Medicare Advantage plans in select counties of Colorado, Illinois, North Carolina, and Virginia, plus Georgia and South Carolina. In addition, Clear Spring Health sponsors Medicare Prescription Drug plans in 42 states.

Job Summary:

The Care Service Coordinator is a non-clinical staff member that helps to coordinate member’s care and help improve member’s compliance with preventive screenings. The Care Services Coordinator is responsible for assisting the Quality Improvement departmental needs.

Main Accountabilities:

• Attend ongoing training and courses, as needed
• Must comply with departmental policies and procedures
• MedHOK administrative support for other departments
• Handles sensitive information in a confidential manner
• Consult and collaborate with member, caregiver and member’s primary care physician to set up member appointments
• Review of claims for the identification of member’s visit to close identified care gaps
• Participates in HEDIS project through the request of medical records (provider office), medical record retrieval and abstraction, if needed
• Research and creates presentations, as needed
• Answers and direct phone calls and assist members with questions
• Consult with members and / or caregiver to discuss identified care gap (i.e. colorectal cancer screening)
• Documents and tracks outbound and inbound calls received using the Member 360 MedHOK platform
• Escalate any issues to immediate supervisor
• Produces, distributes correspondence and responsible for all department mailings
• Resolve administrative issue for the department
• Works in conjunction with other departments based on scope of work
• Generates reports, as applicable