Clinical Services Coordinator

3 days ago


California, United States Blue Shield of California Full time

About the Role

The Clinical Services Coordinator will play a vital role in supporting the Children's Health Program (CHP) team in providing identification, referrals, and care management for Medi-Cal members under 21 years old. This position will collaborate with clinical staff to ensure member needs are met, utilizing established Blue Shield Medical Policies and Guidelines that align with nationally recognized standards.

Key Responsibilities

  • Process faxed/phoned in authorizations, UM/CM requests, and calls left on voicemail
  • Select support for Case Managers, including mailings and surveys
  • Data entry, including authorization forms, high-risk member information, and verbal HIPAA authorizations for case creation
  • Support to Advanced/Specialist CSCs
  • 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 members, employers, and providers
  • Serve as the initial point of contact for members and providers by telephone or correspondence
  • Review specific CHP eligibility referrals within extension of authority
  • Process service authorization referrals and assist with system letters, requests for information, and data entry
  • Provide administrative/clerical support to medical management

Requirements

This role requires strong communication and organizational skills, with the ability to work in a fast-paced environment. The ideal candidate will have experience in healthcare operations and be familiar with medical policies and guidelines.



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