Prior Authorization Coordinator Jobs in Riverside, CA

ABOUT US:

Community health is about more than just vaccines and checkups. It’s about giving people the resources they need to live their best lives. At Neighborhood, this is our vision: a community where everyone is healthy and happy. We’re with you every step of the way, with the care you need for each of life’s chapters. At Neighborhood, we are Better Together.

As a private, non-profit 501(C) (3) community health organization, we serve over 414,000 medical, dental, and behavioral health visits from more than 95,000 people annually. We do this in pursuit of our mission to improve the health and happiness of the communities we serve by providing quality care to all, regardless of situation or circumstance.

Since 1969, our employees have been making this mission a reality. Regardless of the role, our team focuses on being compassionate, having integrity, being professional, always collaborating, and consistently going above and beyond. If this sounds like an organization you would like to be a part of, we would love to meet you!

ROLE OVERVIEW and PURPOSE:

The Patient Care Coordinator works to support the mission and vision of Neighborhood Healthcare by supporting Primary Care Practice teams (PCP) to improve patient health outcomes. The PCC will assist primarily with coordinating and providing panel management services to patient at highest risk for health deterioration and assisting patients achieve their self-care goal by increasing access to health services and resources.

**Please note, this is a temporary full-time position with an anticipated end of assignment in March 2027.**

RESPONSIBILITIES:

• Utilizes the primary care medical home model to provide coordinated team care to address current diseases
• Provides panel management for preventative and health maintenance follow-ups for the maximum number of patients per day
• Contacts new patients to provide a warm welcome to our clinic, explain the medical home, and answer patient questions
• Schedules patients with chronic conditions for follow-up appointments per preventative and maintenance care schedules
• Performs population management tasks, such as appointment scheduling, recalls, web portal callbacks, and addressing telephone encounters
• Makes outreach calls to patients missing appointments based on preventative and chronic disease guidelines
• Delegates ECW telephone encounters and Web Portal messages to medical assistants and providers
• Implements actions for increasing productivity, such as scheduling patients for PCP follow-up visits, anticipating open slots for same day appointments, and proactively maintaining full provider schedules
• Tracks and reports the progress of assigned tasks and logged PCP discussion topics in weekly supervisor meetings
• Collaborates and supports the PCP to identify and implement actions for improving population management and patient care outcomes
• Organizes weekly pre-clinic team huddles to update progress on various goals, such as Meaningful Use compliance and C.A.R.E. Transformation
• Coordinates monthly medical assistant team meetings to discuss progress towards PCMH goals and areas needing improvement
• Provides and documents patient end-of-visit interviews, coaching, and patient engagement conversations
• Reinforces information given to patients and/or family with handouts to improve patient self-management skills and communication
• Provides education to patients during medical appointments, as needed
• Acts as first point of contact for patients and families asking questions and raising concerns through the patient web portal and via phone
• Submits prior authorization for medications, DME supplies, and other items, as needed
• Impacts patient experience by demonstrating values of Transforming Care, including courteous and helpful behavior and a commitment to accuracy
• Shares accountability for overall patient health outcomes by working in coordination with PCP
• Completes ECW notes for all care coordination and other services provided in a timely manner
• Prioritizes activities according to need and required follow-up
• Provides accurate and timely reports to supervisor, as required
• Contributes to the success of the organization by participating in quality improvement activities
• Operates to instill confidence in our care and in our facilities to patients, fellow employees, and other stakeholders
• Assists medical assistant and patients as needed

EDUCATION/EXPERIENCE:

• High school diploma or GED required
• Medical Assistant Certificate/Diploma from an accredited program required
• Current Basic Life Support (BLS) certification required upon hire and must be maintained as a condition of employment. These courses must follow AHA guidelines- may be completed through approved online providers such as ProMed or other equivalent programs that meet recognized BLS standards.
• One year of medical assistant experience within medical home health preferred
• Non-profit community health clinic experience preferred
• Bilingual-English/Spanish preferred

ADDITIONAL QUALIFICATIONS (Knowledge, Skills and Abilities):

• Excellent verbal and written communication skills, including superior composition, typing and proofreading skills
• Ability to interpret a variety of instructions in written, oral, diagram, or schedule form
• Knowledgeable about and experience with medical home health
• Ability to adapt to changing patient or organizational priorities
• Ability to successfully manage multiple tasks simultaneously
• Ability to use critical thinking to make decisions and problem solve.
• Excellent planning and organizational ability
• Ability to work as part of a team as well as independently
• Ability to work with highly confidential information in a professional and ethical manner

Physical Requirements

• Ability to lift/carry 20 lbs/weight
• Ability to stand for long periods of time

Pay Range: $27.21 - $38.09 per hour, depending on experience

Compensation Disclosure: The posted salary range reflects the designated pay grade for this position. While this range represents the broader classification of the role, actual compensation will be based on several factors, including but not limited to: the candidate’s overall knowledge, skills, and experience, market data and industry benchmarks, internal equity within the organization, Budgetary considerations and organizational needs. As a result, placement within the range is not guaranteed, and the full pay grade range may not be utilized.