Member Care Coordinator, Clinical Jobs

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Location:

Category:
Customer Service

Contract Type:
Not provided

Salary:

20.00 - 22.00 USD / Hour

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Job Description:

A Member Care Coordinator sits at the intersection of Member Experience and Clinical Operations. The role of a Member Care Coordinator is to ensure that members receive timely, coordinated, and high quality care; acting as the “glue” between the Clinical, Coaching, and Operational teams. They ensure smooth handoffs between teams, including but not limited to, tracking lab results, medication approvals, and any necessary clinical follow up to ensure members proceed through their journey seamlessly.

Job Responsibility:

Execute critical clinical administrative workflows focusing on resolving readiness barriers to accelerate members toward provider review and medication access
Facilitate provider workflow efficiency by preparing clinical documents and proactively triaging member needs for specialty support
Facilitate structured handoffs of critical information to Clinical and Coaching teams to ensure timely follow-up regarding changes in medication, denials, or approved exception paths
Engage in cross-functional meetings and work collaboratively with others departments to improve and maintain a high level of member care
Identify and formally report recurring systemic issues, submission errors, or trends that contribute to operational friction
Manage the end-to-end medication access workflow with complete ownership, including the proactive gathering of relevant clinical data, coordinating with clinicians for additional necessary information, complex Prior Authorization (PA) submission, denial investigation, appeal documentation, final determination and overrides when applicable
Proactively contact members via phone and secure message to request necessary information (e.g., previous prescription history, documentation) and deliver clarity regarding complex PA status changes or delays
Conduct outbound calls to insurance carriers, PBMs, and pharmacies to obtain specific case statuses, track documentation, and secure approvals
Ensure all communication, investigation notes, and PA statuses are accurately logged in the case management system (e.g., Zendesk, MJD) to maintain a complete and auditable member record
Initiate and resolve pharmacy-level rejections (e.g., refill too soon, insurance coding errors, wrong dose dispensed) by conducting outbound calls to dispensing pharmacies and PBM help desks
Troubleshoot technical or administrative insurance issues that prevent successful claims processing

Requirements:

Completion of a formal medical assisting program is highly valued
Preference will be given to candidates who hold a national certification, such as Certified Medical Assistant (CMA) awarded by the AAMA or Registered Medical Assistant (RMA) awarded by the AMT
Familiarity with case management systems (e.g., Zendesk), Electronic Health Records (EHR), and PA/e-prescribing platforms is highly desirable
2+ years of high-volume customer service, call center, or patient advocacy experience, preferably in a healthcare, pharmacy, or PBM setting
Demonstrated track record of managing complex, multi-step processes where follow-up and persistence are critical to success
Exceptional verbal and written communication skills with the proven ability to handle challenging, escalated calls/messages with professionalism and empathy
Demonstrated proficiency in medical terminology and clinical documentation to accurately interpret patient charts, understand treatment plans, and effectively communicate with clinical providers and payers
Strong organizational skills and meticulous attention to detail in documentation
Proficiency in interpreting and translating complex insurance terminology for the member
Proactive problem solver with a self-starter mentality
Ability to work independently and manage case load effectively

Additional Information:

Job Posted:
December 06, 2025

Work Type:

Remote work

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Member Care Coordinator, Clinical