Clinical Services Coordinator, Intermediate

Blue Shield of California•El Dorado, AR

About The Position

Your Role The Clinical Service Coordinator plays a vital role in outreach and engagement efforts with our members as well as supporting clinical staff with day-to-day operations. The CSC responsibilities range from introducing members to care management services to assisting providers with intake. A CSC may interact telephonically with members and/or providers to assist with simple care coordination needs and facilitate connections. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Responsibilities Your Work In this role, you will:

Requirements

Requires a high school diploma or equivalent
Requires at least 3 years of prior relevant experience
May require vocational or technical education in addition to prior work experience
Experience with health insurance/ managed care (Commercial, Medicare, and Medi-Cal) and community resources and advocacy
Ability to identify issues and develop effective solutions to meet members' needs
Available to work a scheduled 8-hour shift, which includes 2 scheduled breaks and a lunch period, M-F between 8am and 7pm.
Available to work occasional weekends as part of a quarterly rotation.
Flexibility to adjust to changing circumstances and member needs
Strong verbal and written communication skills to effectively convey information to members and colleagues

Responsibilities

Work in a production-based environment with defined production and quality metrics
Process Faxed /Web Portal /Phoned in Prior Authorization or Hospital Admission Notification Requests, Utilization Management (UM)/Case Management (CM) requests and/or calls left on voicemail.
Conduct telephonic outreach efforts to engage members and introduce them to care management services.
Complete thorough assessments to identify member needs and care gaps
Select support for Case Manager such as mailings and surveys.
Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.
Provide support to Advanced/Specialist CSC.
Assign initial Extension Of Authority (EOA) days, or triage to nurses, based on established workflow.
Research member eligibility/benefits and provider networks.
Serves as the initial point of contact for providers and members in the medical management process by telephone or correspondence.
Maintain accurate and up-to-date member records and documentation of all interactions and services provided
Conduct follow-up calls to ensure members’ needs are being met
Provide members with information and resources about available care management services and how to access them
Acts as a liaison, gathers information, and tracks all patients referred to the care management programs.
Assists in coordinating care for specific high risk/high-cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc.
Intake (received via fax, phone, or portal).
Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.