Care Coordinator

Company Description: Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities. We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity. Position Responsibilities: Specific Conduct clinical review of prior authorization, concurrent review, and retrospective review requests to determine medical necessity and appropriateness of services. Collaborate with utilization management nurses and clinical staff to support timely decision-making. Review appeals and grievances related to medical necessity and participate in fair hearing processes as required. Ensure compliance with federal and state regulations, NCQA/URAC standards, and MCO policies. Serve as a liaison between the medical management department and providers, offering guidance on clinical criteria and utilization trends. Participate in interdisciplinary rounds and case review meetings as needed. Identify utilization trends and contribute to the development of policies, clinical criteria, and medical management strategies. Support quality improvement initiatives and population health programs as needed. General Provide strategic direction for hea