Your Role

The clinical services coordinator (CSC) will report directly to the supervisor of care management support operations and will serves as initial point of contact for providers and members in the medical management process by telephone or correspondence. The CSC will interact telephonically with members as per established protocol or direction to ensure that members are effectively and efficiently managed through the medical/disease management process as needs require and in helping the RN care manager or social worker in arranging appropriate medical equipment (DME), home health, follow-up appointments, and other services related to care coordination.

Your Work

In this role, you will:

• Telephonic outreach to conduct the Health Risk Assessment (HRA) with the member
• Telephonic outreach to members as directed by protocol or RN care manager or social worker.
• Assists with system letters, requests for information and data entry.
• Back up to phones when needed.
• Provides administrative/clerical support to medical and disease management programs.
• Acts as a liaison, gather information, and track all patients referred to the care management programs.
• Assists in coordinating care for specific high risk/high-cost patient population, including referrals t community resources, facilitation of medical services, referral to ancillary providers, etc.
• Documents all patient specific information in appropriate information systems.
• Assists in verifying health plan benefits and coordinating ambulatory services.
• Demonstrates cultural competence to work effectively, respectfully, and sensitively within the client's cultural context.
• Assists with precepting responsibilities for new hires and auditing efforts.

Your Knowledge and Experience

• A minimum of a high school diploma
• A minimum of 3 years of relevant experience
• A minimum of 1 year experience in a managed care environment.
• Bi-Lingual in Spanish required
• Health insurance/ managed care experience (Commercial, Medicare, and Medi-Cal)
• Community resources and advocacy
• Practice integration in a triad model of care

Pay Range:

The pay range for this role is: $ 20.47 to $ 28.66 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.