Job Description:Your RoleThe 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 WorkIn 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.
Qualifications: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.About the Team:Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California's top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!Our Values:
Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
Our Workplace Model:Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That's why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.Two ways of working: Hybrid (our default) and office
Hybrid - In a business unit approved office a few times per year to 3 days per week, on average
Office - In a business unit approved office 4+ days a week, on average. If the role you're applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.
Physical Requirements:Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.Equal Employment Opportunity:External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
