# Medical Services Coordination Specialist I [CDPHP](https://www.jorb.ai/firms/cdphp.md) · New York · United States · [Administrative / Others](https://www.jorb.ai/jobs/administrative-others.md) CDPHP is hiring a Medical Services Coordination Specialist I in New York. Posted 2026-07-20; applications close 2026-09-18. **Apply**: https://careers.cdphp.com/us/en/job/EBXCDPUSJR103657EXTERNALENUS/medical-services-coordination-specialist-i Posted 2d ago. ## Role details ## Job Summary This position supports the workflow of the Medical Services division. The Medical Services Coordination Specialist provides support for programs within Behavioral Health, Quality Management, and Member Care Management. Responsibilities include adhering to applicable regulatory requirements and helping connect members to appropriate internal Health Plan resources, the Clinical Case Management team, and external community support systems. ## Essential Accountabilities ### Level I - Review and prepare clinical cases for clinical staff. - Assess members’ needs using Health Plan–approved case management guidelines and assessment tools; make appropriate referrals to clinical programs. - Collaborate with the clinical care team to support enrollees; work with the enrollee/caregiver/legal guardian to identify and achieve shared treatment goals. - Manage a caseload productively and maintain documentation according to Health Plan standards. - Provide advocacy for members and their support systems; encourage self-sufficiency by addressing social determinants of health, providing effective coaching, and making referrals to case and disease management as needed. - Link enrollees with resources and empower them to use those resources effectively, ensuring referrals result in timely appointments. - Monitor member engagement and follow up on outstanding actions to ensure closure of care gaps and completion of required assessments. - Engage members through multiple communication channels (phone, messaging, and digital tools) to support improved health outcomes. - Explore multiple sources of information to identify members with gaps in care, aligning with HEDIS quality measures and Value Based Payment Programs. - Communicate effectively to provide outreach and education on health care quality metrics; assess barriers to care; intervene as appropriate to assure access or facilitate referrals to improve health outcomes (e.g., access to care, preventive health, chronic diseases, and health equity). - Coordinate access to transportation, pharmacy, grocery store, food pantry, and other community resources as needed to meet care plan goals. - Prepare and assist in handling member and provider correspondence related to disease conditions and/or care management program services, ensuring accuracy and timeliness of processing. - Manage relevant Behavioral Health/Member Care Management/Quality voice and email inboxes and/or Stored Information Retrieval (SIR) queues throughout the day for messages, potential care management referrals, and relevant clinical documentation. - Adhere to unit Service Level Agreements (SLAs), internal and external regulatory commitments, and regulatory timeframes to meet expectations of state partners. - Ensure end-to-end process for care management referrals is accurate and complete by collaborating with other internal departments. - Non-care manager support staff duties may include requesting medical records, mailing educational materials, and answering/responding to telephone calls and emails as long as duties are non-clinical in nature. - Perform intake assessment and triage functions for each call to the appropriate Member Care Management/Quality service area; provide preliminary support to providers and others as needed, including physicians, skilled nursing facilities, mid-level providers, and members. - Communicate with members and service providers according to regulatory agency requirements and/or organizational guidelines. - Demonstrate high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct and Lifetime Way Values and Beliefs. - Maintain member privacy in accordance with corporate privacy policies and procedures. - Maintain regular and reliable attendance. - Perform other functions as assigned by management. ### Level II (in addition to Level I Accountabilities) - Prioritize work and provide instruction, advice, and guidance to more junior staff regarding unit processes, procedures, and business systems. - Support training and onboarding of new staff. - Mentor newer staff and troubleshoot unit-related questions. - Serve as an intermediary between staff and management to alert leadership of potential barriers or challenges. - Review and bring forward recommendations to ensure desk-level procedures and process workflows remain current and relevant. - Produce care management statistics daily and as needed for department metrics, including case and review timeliness, workflow volumes, and referrals generated to care management programs. ### Level III (in addition to Level II Accountabilities) - Assist the supervisor with control and monitoring of inventory levels for the assigned department based on established priorities and performance standards. - Assist the supervisor with monitoring and evaluating workflow to ensure timeliness and unit standards are met; provide reporting, analysis, and recommendations to unit management based on day-to-day observations. - Assist in updating departmental policies, procedures, and desk-level procedures relative to department functions; identify and develop processes and guidelines for performance improvement, productivity, and efficiency gains. - Handle complex issues, escalated customer questions, high-maintenance or high-priority customers for the assigned business unit, and high-dollar/high-cost member investigations. - Assess staff and unit training needs and report findings to the supervisor. - Identify eligibility and coverage and assist other staff and other areas within the company with related inquiries. - Collaborate with internal departments regarding changes in processes/systems; identify problems and recommend logical and effective solutions. ## Minimum Qualifications This role includes multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision-making, and—at times—becoming a resource to others. This approach guides placement of new hires and supports employee development and promotional opportunities. ### All Levels - Minimum of one year of experience working in an insurance company, medical assistant role, or Health Plan customer service; delivering care coordination at a community-based organization; or working within a patient-facing medical care setting. - Working knowledge of medical terminology. - Demonstrated proficiency with the Microsoft Office Suite. - Excellent oral and written communication skills. - Demonstrated organizational and interpersonal skills; ability to manage multiple tasks under pressure. - Ability to utilize department-specific applications and software, including a care management system and department libraries. - Ability to utilize engagement strategies to connect with the population served (e.g., motivational interviewing). - Attention to detail. ### Level II (in addition to Level I Qualifications) - Minimum of three years’ experience working in an insurance company, delivering care coordination at a Community Based Organization, or in a medical care setting. - Ability to develop and apply in-depth knowledge of complex rules, including care management systems and processes, departmental policies and procedures, product lines, and regulatory requirements. - Broad understanding of multiple areas of the company and willingness to develop collaborative solutions to achieve improved end-to-end processes. - Ability to recognize sensitive issues and/or significant areas of concern and know when to escalate to management. - Demonstrated ability to lead committee activities and support newer team members. - Consistently exceed minimum productivity standards established by the department. - Ability to identify opportunities for process improvement and participate in resolution of more complex issues/activities. ### Level III (in addition to Level II Qualifications) - Minimum of five years of experience working in an insurance company or medical care setting. - Thorough knowledge and understanding of health plan contracts, regulatory requirements, and unit procedures. - Knowledgeable in multiple systems and/or processes that enable effective and efficient identification of data or process issues to resolve related concerns. - Ability to precept new staff, take on more complex challenges, demonstrate flexibility and independence in work assignments, and participate in meetings and special projects. - Ability to identify process efficiencies and develop a plan of action to implement improvements. - Demonstrated presentation skills. ## Physical Requirements - Ability to work prolonged periods sitting and/or standing at a workstation and using a computer. - Ability to work while sitting and/or standing at a workstation viewing a computer and using a keyboard, mouse, and/or phone for three (3) or more hours at a time. - Ability to work in a home office for continuous periods of time for business continuity. - Ability to travel across the Health Plan service region for meetings and/or trainings as needed. - Ability to hear, understand, and speak clearly while using a phone, with or without a headset. ## Compensation Range(s) - Level I (N3): Minimum $20.40 – Maximum $27.00 - Level II (N4): Minimum $20.80 – Maximum $30.80 - Level III (N5): Minimum $21.20 – Maximum $33.03 The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, and internal equity. The posted salary range reflects one component of the total rewards package. Other components may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays. ## Equal Opportunity All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. ## Applying to this role This Medical Services Coordination Specialist I role at CDPHP runs through the firm's own careers portal and expects a CV and cover letter written specifically for the posting, not a portable submission carried across firms. Jorb AI's application agent tailors a CV and cover letter from your background to this posting and tracks the role alongside the rest of your applications. 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