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Job Description

Position Summary

Community Alliance Medical Group (CAMG) seeks an organized, proactive coordinator to support timely access to specialty care, improve primary care quality performance, and advance value-based care initiatives. This combined role processes referrals and authorization requests while coordinating quality measure tracking, Annual Wellness Visit campaigns, Accountable Care Organization (ACO) initiatives, and other special projects.

The coordinator works with physicians, clinical teams, clinic leaders, health plans, Independent Practice Associations (IPAs), and ACO partners to identify care gaps, organize patient outreach, track results, and follow projects through completion. Leadership establishes workload priorities and campaign timelines across these responsibilities.

Referral and Authorization Coordination

• Process referrals and prior authorization requests for specialty consultations, diagnostic services, procedures, and other ordered services; verify eligibility, network participation, and authorization requirements.
• Review requests for required orders and supporting documentation, obtain missing information from the appropriate team, and submit complete requests through designated systems.
• Monitor pending requests, authorization expirations, returned submissions, and denials; coordinate corrections and supporting materials and escalate barriers promptly.
• Prioritize time-sensitive requests according to provider direction and established workflows; communicate authorization status and scheduling instructions to patients and care teams.
• Track referrals through scheduling, service completion, and receipt of consultant reports or results; follow up on incomplete referrals and route clinical findings to the treating team.

Quality Measures and Care Gap Management

• Maintain patient worklists and performance trackers using electronic health record reports and health plan, IPA, and ACO data; reconcile discrepancies with the appropriate partners.
• Monitor adherence to applicable quality measure workflows, including HEDIS, Medicare Star Ratings, preventive screenings, chronic condition monitoring, and other assigned program measures.
• Coordinate outreach and scheduling for patients with identified care gaps; track completed services and obtain outside records to support accurate reporting.
• Work with providers and clinical staff to resolve documentation gaps, support accurate data submission, and improve workflows. Clinical assessment, treatment, and coding decisions remain with appropriately qualified personnel.

Annual Wellness Campaigns and Value Based Care Programs

• Coordinate Annual Wellness Visit campaigns, including eligible patient lists, outreach, scheduling, reminders, completion tracking, and follow-up on missed appointments.
• Partner with clinic, billing, and coding teams to reconcile completed wellness visits with documentation and billing status and identify outstanding follow-up needs.
• Support ACO and other value-based care initiatives by translating program requirements into organized worklists, outreach activities, deliverables, and reporting timelines.
• Track assigned quality, preventive care, patient engagement, and utilization-related performance indicators; flag barriers and recommend practical improvements.
• Coordinate with external program partners on attributed patient lists, reporting discrepancies, performance updates, and assigned improvement activities.

Special Projects and Performance Reporting

• Coordinate assigned projects from planning through completion, maintaining timelines, task owners, status updates, and follow-up items.
• Prepare concise dashboards and progress reports showing referral status, care gaps, wellness visit completion, program results, and outstanding actions.
• Support consistent workflows across CAMG locations, including staff education, process updates, and follow-up on implementation.
• Protect patient confidentiality, maintain accurate records, and follow CAMG policies and applicable privacy requirements; perform related duties as assigned.

Required Qualifications

• High school diploma or equivalent and at least two years of relevant experience in referrals, authorizations, medical office operations, quality improvement, or population health.
• Working knowledge of managed care referrals, insurance verification, authorization workflows, and medical terminology.
• Proficiency with electronic health records, payer portals, Excel, and patient or project tracking tools.
• Strong organization, attention to detail, patient communication, and follow-through; ability to manage competing deadlines and work independently while collaborating across teams.

Preferred Qualifications

Experience in primary care, Medicare Advantage, HMO or IPA operations, ACO programs, HEDIS, Medicare Star Ratings, Annual Wellness Visits, or care-gap outreach. Experience with eClinicalWorks and building performance reports is preferred. Medical assistant training or a related associate or bachelor’s degree is a plus.

Measures of Success

Performance is evaluated against leadership-established targets for timely and accurate referral submissions; follow-up on aged and incomplete referrals; patient outreach and care-gap closure; wellness visits scheduled and completed; reliable quality and ACO reporting; and timely completion of assigned projects. Shared clinical and program outcomes are evaluated in collaboration with the responsible teams.

Pay: $23.00 - $30.00 per hour

Expected hours: 40.0 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: In person