Clinical Operations Coordinator

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlus has been committed to building strong relationships with its members and providers.

Position Overview: 

Empower. Unite. Care.

MetroPlusHealth is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.

The Clinical Operations Coordinator reports to the Clinical Operations Manager and is responsible for facilitating day-to-day operations of the Utilization Management team related to workflow management. The Clinical Operations Coordinator is the Subject Matter Expert (SME) for workflow case assignment management including scheduling, regulatory timeframe compliance, and peer to peer processes. The Clinical Operations Coordinator is a technically savvy individual who can complete multiple tasks accurately and efficiently while also providing the necessary information to management to make timely adjustments to ensure all regulatory requirements are met. 

The Clinical Operations Coordinator functions as the information gateway to facilitate interdepartmental communications across all UM. The Clinical Operations Coordinator will assist in the management of departmental workflows, and function as the departmental ambassador and liaison.   

• Assists with daily case workload and appeal assignment through monitoring work queues in real time to ensure completion in a timely manner.
• Runs and delivers reports multiple times a day to UM management to support turn-around time compliance across all UM teams.
• Manages the peer-to-peer designated call line and ensures prompt provider call back, scheduling peer-to-peer requests and ensures process completion.
• Maintains Medical Directors’ calendars and schedules related to UM to ensure adequate coverage.
• Coordinates UM operational meetings and trainings sessions. Documents and distribute agendas, and meeting minutes.
• Schedules and ensures completion of all required corporate and job-related training.
• Establishes, updates, and maintains department’s files, inventories, and records; implements and maintains data management systems.
• Assists in developing reference documents using various software applications.
• Assists in the coordination and completion of special projects as appropriate.
• Coordinates Medical Director group email and chat functionality.
• Effectively communicates with all stakeholders.
• Actively participates in reporting development to support real-time compliance monitoring, productivity and utilization operational trend reports.

• High School Degree or equivalency; and
• 5 years of relevant experience required; or
• A satisfactory equivalent combination of education, training, and experience.
• Strong Microsoft Office product abilities (Outlook, Word, Excel, PowerPoint, Teams)
• Solid entry-level working understanding of Utilization Management and the role of a Medical Director, including regulatory requirements. 
• Prior UM administrative coordination experience in a managed care setting preferred

Professional Competencies

• Integrity and Trust.
• Customer Focus.
• Functional/Technical Skills.
• Advanced computer literacy, excellent written and oral communication skills required.
• High degree of diplomacy and tact.
• Ability to work in a fast-paced environment with multiple stakeholders.
• Ability to apply innovative approaches to solve problems in a timely and efficient manner
• Demonstrated ability to maintain confidentiality, and to make administrative/procedural decisions and judgments independently

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