Clinical Program Coord Jobs

We’re looking for colleagues who are ready to Think Big, Go Fast, Deliver Awe, and Win Together. These core values embody our diverse and inclusive culture and help us live out our mission of “getting people the care they need when they need it.” Over the last 30 years, our company has established itself as the market leader in managed care for the workers’ compensation industry. We are committed to making a positive impact in the lives of the injured workers we serve, and we have fun doing it.

Salary Range: 16.50 - 18.75 Hourly

This compensation range takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At One Call, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is 16.50 - 18.75 Hourly

Benefits Summary

In return for your commitment to our company’s mission, we offer a vast array of benefits to help support the whole you.

• Company paid life insurance
• Healthcare concierge
• Colleague Assistance Program that provides free counseling and financial services
• Pre-Tax FSA and HSA health savings accounts
• Competitive wages with opportunities to earn annual merit increases
• The One Call Foundation which aims to help colleagues during unexpected emergencies, from car accidents to natural disasters.
• 401(k) matching
• Medical, dental, and vision insurance
• Tuition Reimbursement Program including certifications
• Opportunities to work from home
• Referral program
• Enterprise Recognition Program rewarding colleagues for their extraordinary work
• Company paid short term and long-term disability
• $1,000 Colleague Referral Program
• Paid development hours to use for professional and community development!
• Exclusive discounts on travel, activities, and merchandise via work discount program
• Generous paid time off, 8 company holidays, and 2 floating holidays per year
• Quantum Health: A healthcare navigation platform to help our colleagues make the best, most cost-effective healthcare decisions

Job Summary

The PT Clinical Program Coordinator manages the referral handling components of the Clinical Review process for various service types, to enable successful completion and in a timely manner. They work closely with the One Call licensed Clinical Reviewers and assist in communication of professionally rendered recommendations, while maintaining and strengthening professional relationships with internal and external customers. The PT Clinical Program Coordinator must be able to thoroughly audit the referrals, to confirm referral data integrity for appropriate implementation of the Clinical Review process and the respective various outcomes of the team’s recommendations.

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 with occasional 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.

General Duties & Responsibilities

Data Integrity: 40%

• Reviews Functional Capacity Evaluation documentation to confirm all required information is present per respective request type
• Reviews the entire completed Gold Standard Review™ for accuracy and avoidance of non-supported language or recommendations.
• Audits referral to confirm appropriate candidacy for Clinical Review: identifying and correcting errors, validating Rx/auth/treatment for body part and diagnosis, and validating Progress Summaries on file
• Processes the Discharge Queue to input data from Provider Discharge Summaries for relaying One Call outcomes to customers.
• Monitors discharge dates input on Gold Standard Review™ to determine why referral has not been discharged and if a discharge Gold Standard Review™ is needed.

Communication: 35%

• Updates referral authorization and relays to provider or revises authorization already given to provider.Communicates requirements to payors and providers on needed information for independent clinical reviews.
• Handles all correspondences with Adjuster and/or Case Manager to obtain original or modified authorization for the injured worker.
• Communicates Gold Standard Review™ results to Adjuster and/or Case Manager, including any outstanding provider or reviewer requests for information.
• Gathers all information to email and/or fax to payor.

Collaboration: 25%

• Handles the At Risk Program, to include tracking the triggering of candidates and reporting outcomes.
• Works closely with core Operations teams to handle all Case Rate Program referral appeals, Letter of Medical Necessity’s, diagnosis change requests.
• Educates providers on the avoidance of alternative service recommendations within FCEs, pursuing addendums when needed.
• Serves as primary contact for any PT Clinical related needs for other One Call products and teams.
• Adheres to all insurance company client directives and escalates any needs for additions or modifications.
• Provides re-education and support regarding One Call’s Gold Standard Review™ program to payor and providers with various inquiries.

Educational And Experience Requirements

• Must have an introductory level understanding of clinical or medical terminology.
• Experience in a therapeutic rehabilitation setting is premium.
• Prefer experience in clinical or medical office setting.
• Associate’s degree is required; Bachelor’s degree is preferable; or the equivalent combination of education, training, and work experience.

General Knowledge, Skills & Abilities

• Ability to function well in a high-paced and at times stressful environment.
• Strong analytical and problem-solving skills.
• Excellent interpersonal and customer service skills.
• Excellent verbal and written communication skills.
• Proficient with Microsoft Office.
• Ability to prioritize tasks and to delegate them when appropriate.
• Excellent time management skills with a proven ability to meet deadlines.
• Excellent organizational skills and attention to detail.

Physical/Emotional Demands & Work Environment

• 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 this job description is subject to change at any time.
• The employee is occasionally required to lift objects (up to 10lbs weight; up to 4 ft. height).
• The emotional demand of the job may cause undue stress from, but not limited to, moderate/heavy workload.
• 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.
• Specific vision abilities required by this job include ability to see things from a close distance and ability to adjust focus

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Job Snapshot

Employee Type

Full-Time

Location

Jacksonville, FL (Onsite)

Job Type

Health Care

Experience

Not Specified

Date Posted

06/13/2023