Clinical Services Coordinator

The Clinical Services Coordinator is responsible for coordinating clinical services and providing Quality Assessment and Utilization Review (QA/UR) Management for the Pascua Yaqui Maricopa/Pima County Managed Care Program.

• Assist the Associate Director of Health with duties that include prioritize and assign work, provide input for performance evaluations, ensure staff are trained and follow policies and procedures, maintain a healthy and safe working environment, and if directed provide staff supervision.
• Process and coordinate medical referrals for the Phoenix Indian Medical Center (PIMC) to provide healthcare for tribal members in Maricopa County by scheduling appointments, generating purchase orders and explaining procedures.
• Review medical referrals and claims with assigned committee members; determine medical need, priority of request, eligibility, payer, and provide authorization of payment.
• Act as an advocate for patients and performs liaison activities between patients and healthcare providers; provide patient education about eligibility, diagnosis, and insurance.
• Work closely with the Native American Liaison for AHCCCS ensuring equal treatment for our tribal members.
• Monitor contractors to ensure they follow contract in providing health services to tribal members.
• Participate in discharge planning for patients to ensure appropriate services are in place and that the client is being discharged to an appropriate level of care.
• Perform other duties of a similar nature or level as requested by supervisor or director.
  
  

Knowledge of:

• Indian Health Service Programs, policies and procedures;
• Community health resources;
• Nursing practices and procedures;
• Medical terminology;
• Customer service principles;
• Regulations and procedures of hospitals or clinics as they relate to nursing services;
• Assess the necessity and urgency of requests for medical services to be provided to members in order to determine payment for the service;
• Monitor and report abnormal trends/variations in healthcare patterns;
• Promote excellence and professionalism in healthcare quality;
• ICD-9 and CPT coding guidelines;
• Resource and Patient Management System (RPMS) or similar patient information tracking system;
• Provide clinical review for all requests for home health and physical therapy, making appropriate assessments for approving payment for the service;
• Maintain a professional approach with confidentiality;
• Yaqui culture, customs, resources and traditions and/or a willingness to learn.
  
  

Skills and Abilities:

• Assess the necessity and urgency of requests for medical services to be provided to members in order to determine payment for the service;
• Identify issues and able to provide resolutions;
• Remain resourceful and calm in emergencies;
• Use computers and related software applications;
• Monitor and report abnormal trends/variations in healthcare patterns;
• Promote excellence and professionalism in healthcare quality;
• Provide clinical review for all requests for home health and physical therapy, making appropriate assessments for approving payment for the service;
• Maintain a professional approach with confidentiality;
• Operate a variety of office equipment, including a computer and related software applications;
• Good communication and interpersonal skills as applied to interaction with co-workers, supervisor, management, Council members, and the public. Have ability to sufficiently exchange or convey information and receive verbal and written work instructions.
  
  

Bachelor's Degree in Nursing, plus three (3) years of nursing experience and one (1) year of QA/UR experience; or, an equivalent combination of education and experience sufficient to successfully perform the essential duties of the job such as those listed above.

AND

• Must possess and maintain a valid Arizona Driver's License.
  
  

Special Requirements:

• Current licensed as a Registered Nurse issued by the Arizona State Board of Nursing.
• This position will require the incumbent to work non-traditional hours, nights, and weekends.
• Must have a current Level 1 Arizona Clearance Card or be able to obtain the Level 1 Arizona Clearance Card within ninety (90) days of hire. Failure to maintain a current Level 1 Clearance Card will result in termination from this position.