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Clinical Services Coordinator, Intermediate

Company: Blue Shield of CA
Location: Rancho Cordova
Posted on: January 17, 2020

Job Description:

Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution. We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.

Clinical Services: Federal Employee Program

* Provides operational support to ensure healthcare services are provided to meet member, employer, and provider needs.

Clinical Services Coordinator:

* Serves as initial point of contact for providers and members in the medical management process by telephone or correspondence.

* Assists in ensuring members are effectively and efficiently managed through the medical/disease management process as needs require.

* Within extension of authority, assigns length of stay on acute inpatient admissions, as well as approves specific home health, DME.

* Process authorization requests and facilitates referrals.

* Assists with system letters, requests for information and data entry.

* Provides administrative/clerical support to medical and disease management.

Essential Responsibilities:

* Answer large volume of inbound calls 50 per day.

* Intake (faxed in authorizations, and/or calls left on voicemail).

* Select support for Case Manager such as mailings, surveys.

* Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.

* Support to Senior/Lead HCS.

* Responds to inquiry calls on a limited basis.

* Assign initial EOA days.

* Advance cases to senior staff.

* Research networks.

* Complete morning CSC callbacks

* Other duties as assigned.

Clinical Services: Federal Employee Program

* Provides operational support to ensure healthcare services are provided to meet member, employer, and provider needs.

Clinical Services Coordinator:

* Serves as initial point of contact for providers and members in the medical management process by telephone or correspondence.

* Assists in ensuring members are effectively and efficiently managed through the medical/disease management process as needs require.

* Within extension of authority, assigns length of stay on acute inpatient admissions, as well as approves specific home health, DME.

* Process authorization requests and facilitates referrals.

* Assists with system letters, requests for information and data entry.

* Provides administrative/clerical support to medical and disease management.

Essential Responsibilities:

* Answer large volume of inbound calls 50 per day.

* Intake (faxed in authorizations, and/or calls left on voicemail).

* Select support for Case Manager such as mailings, surveys.

* Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.

* Support to Senior/Lead HCS.

* Responds to inquiry calls on a limited basis.

* Assign initial EOA days.

* Advance cases to senior staff.

* Research networks.

* Complete morning CSC callbacks

* Other duties as assigned.

* Requires minimum 3 years of Customer Service and phone experience.

* Requires AuthAccel use and experience with high volume inbound calls.

* May require vocational or technical education in addition to prior work experience.

* Prior experience working in a call center environment, providing phone support for the entire shift.

* Requires minimum 3 years of Customer Service and phone experience.

* Requires AuthAccel use and experience with high volume inbound calls.

* May require vocational or technical education in addition to prior work experience.

* Prior experience working in a call center environment, providing phone support for the entire shift.

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.

Keywords: Blue Shield of CA, Sacramento , Clinical Services Coordinator, Intermediate, Healthcare , Rancho Cordova, California

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