Clinical Operations Coordinator - TSS

Clinical Operations Coordinator Guaynabo, PR About Us At Triple S, we are committed to provide meaningful job experiences for Valuable People (Gente Valiosa). We encourage an environment of very high ethical standards, always excelling in service, collaboration among the company, agility to deliver timely, and embracing accountability for results. When you join Triple S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses. Let's build healthier communities together, join now! About The RoleThe Clinical Operations Coordinator is responsible for overseeing and managing a variety of clinical operational functions across different areas of healthcare services. This position requires a versatile individual who can adapt to different operational needs, including but not limited to pre-authorization of services, preventive care management, acute care management, complex care management, health education for providers and patients, community preventive initiatives, mental health coordination, and collaboration with delegated entities. The Clinical Operations Coordinator ensures that all tasks are completed in compliance with healthcare standards, while working collaboratively with various teams to optimize patient care and operational efficiency.What You'll Do Coordinate the pre-authorization process for medical services and procedures, ensuring timely and accurate approvals in line with organizational policies and clinical guidelines. Collaborate with healthcare providers to gather necessary documentation and ensure appropriate justification for services. Support the implementation and coordination of Clinical Operations programs aimed at improving patient health outcomes and reducing long-term healthcare costs. Monitor patient progress in preventive care initiatives and ensure follow-up actions are taken when necessary. Prepare and monitoring the assigned budget, ensuring it stay within the established limits. Coordinate acute care services, ensuring that patients receive timely and effective care during acute episodes of illness. Work closely with medical teams to track patient conditions and facilitate appropriate interventions. Maintain continuous communication with the finances department to analyze the income and expenses within the assigned budget Report any significant discrepancies in the budget and propose corrective solutions Assist in preparing reports, presentations and material as required by the team. Advocate for patients, providing guidance and resources to ensure they receive appropriate care and support. What You'll BringBachelor’s Degree (BD) in Office Administration, Health Science, Nursing, Health Education, Nutrition, Social Worker, or any health-related profession with one (1) to three (3) years of experience. Current/valid professional license without restrictions, if applies. CLOSING DATE: 11/24/2025 It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans”. Employer with E-Verify to verify the eligibility of employment of all the new employees.We encourage Veterans and Disabled to Apply