We have other current jobs related to this field that you can find below
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Clinical Services Coordinator, Intermediate
1 week ago
Long Beach, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator, Intermediate (CSC) will report directly to the supervisor of care management support operations and will serve 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...
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Clinical Services Coordinator, Intermediate
1 week ago
Long Beach, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator, Intermediate (CSC) will report directly to the supervisor of care management support operations and will serve 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...
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Clinical Services Coordinator, Intermediate
1 week ago
Long Beach, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator, Intermediate (CSC) will report directly to the supervisor of care management support operations and will serve 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...
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Clinical Services Coordinator, Intermediate
7 days ago
Long Beach, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator, Intermediate (CSC) will report directly to the supervisor of care management support operations and will serve 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...
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Clinical Services Coordinator, Intermediate
1 week ago
Long Beach, CA, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator, Intermediate (CSC) will report directly to the supervisor of care management support operations and will serve 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...
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Clinical Services Coordinator, Intermediate
1 week ago
Long Beach, CA, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator, Intermediate (CSC) will report directly to the supervisor of care management support operations and will serve 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...
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Long Beach, CA, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator, Intermediate (CSC) will report directly to the supervisor of care management support operations and will serve 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...
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Clinical Services Coordinator, Intermediate
1 week ago
Long Beach, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi-Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement, and...
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Clinical Services Coordinator, Intermediate
1 week ago
Long Beach, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi-Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement, and...
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Clinical Services Coordinator, Intermediate
7 days ago
Long Beach, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi-Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement, and...
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Clinical Services Coordinator, Intermediate
1 week ago
Long Beach, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi-Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement, and...
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5 days ago
Long Beach, California, United States Blue Shield Of California Full timePosition OverviewThe Intermediate Clinical Services Facilitator will directly report to the supervisor overseeing care management support operations. This role serves as the primary contact for healthcare providers and members involved in the medical management process, utilizing both telephone and written communication. The Facilitator will engage with...
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Clinical Services Coordinator, Intermediate
1 week ago
Long Beach, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi-Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement, and...
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Clinical Services Coordinator, Intermediate
1 week ago
Long Beach, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi-Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement, and...
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Clinical Services Coordinator, Intermediate
1 week ago
Long Beach, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi-Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement, and...
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2 days ago
Long Beach, United States Blue Shield of California Full timeYour RoleThe Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi-Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement, and...
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Clinical Services Coordinator, Intermediate
1 week ago
Long Beach, CA, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi-Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement,...
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Clinical Services Coordinator, Intermediate
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Long Beach, CA, United States Blue Shield of California Full timeYour Role The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi-Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement, and...
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Clinical Services Coordinator, Intermediate
1 month ago
United States, CA, Long Beach, 90802 Blue Shield of California Full timeYour Role The Clinical Services Coordinator, Intermediate (CSC) will report directly to the supervisor of care management support operations and will serve 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...
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Clinical Services Coordinator, Intermediate
1 week ago
United States, CA, Long Beach, 90802 Blue Shield of California Full timeYour Role The Clinical Services Coordinator, Intermediate (CSC) will report directly to the supervisor of care management support operations and will serve 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...
Clinical Services Coordinator, Intermediate
2 months ago
Your Role
The Children’s Health Program (CHP) team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team. The Clinical Services Coordinator Intermediate will report to the CHP Manager. In this role you will work with clinical staff to support member needs using the established and approved Blue Shield Medical Policies and Guidelines which align with nationally recognized standards. You will be responsible for working daily inventory, processing medical records and requests, fax intake, referral intake, and other duties as assigned.
Your Work
In this role, you will:
- Process faxed/phoned in authorizations, UM/CM requests 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 Advanced/Specialist CSC
- Assign initial EOA days, or triage to nurses, based on established workflow
- Research member eligibility/benefits and provider networks
- Provide operational support to ensure healthcare services are provided to member, employer, and providers
- Serve as the initial point of contact for members and providers by telephone or correspondence
- Within extension of authority, review specific CHP eligibility referrals
- Process service authorization referrals and assist with system letters, requests for information and data entry
- Provide administrative/clerical support to medical management
Your Knowledge and Experience
- Requires basic job knowledge of systems and procedures obtained through prior work experience or education.
- Typically, requires minimum of 3 years of experience. May require vocational or technical education in addition to prior work experience.
- Requires UM regulatory TAT standards
- Requires basic job knowledge of systems and procedures obtained through prior work experience or education
- At least 1 year work experience within the Medical Care Solutions Utilization Management Department or a similar medical management department at a different payor, facility, or provider group
- In-depth knowledge of the prior authorization and/or concurrent review non-clinical business rules and guidelines, preferably within the inpatient, DME and/or Home Health areas related to children
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.
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