Intermediate Clinical Services Facilitator
2 weeks ago
Position Overview
The 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 members according to established protocols to ensure they are effectively navigated through the medical and disease management processes, while also assisting the RN care manager or social worker in organizing necessary medical equipment, home health services, follow-up appointments, and other care coordination activities.
Key Responsibilities
In this position, you will:
- Conduct telephonic outreach to perform Health Risk Assessments (HRA) with members.
- Engage with members as directed by established protocols or by the RN care manager or social worker.
- Assist with system-generated correspondence, information requests, and data entry tasks.
- Provide backup support for phone inquiries as needed.
- Offer administrative and clerical assistance to medical and disease management initiatives.
- Act as a liaison to gather information and monitor all patients referred to care management programs.
- Support care coordination for specific high-risk or high-cost patient populations, including referrals to community resources and facilitation of medical services.
- Document all patient-specific information in the appropriate information systems.
- Assist in verifying health plan benefits and coordinating outpatient services.
- Exhibit cultural competence to work effectively and respectfully within diverse client backgrounds.
- Participate in precepting new hires and contribute to auditing efforts.
Qualifications and Experience
- Basic knowledge of systems and procedures acquired through prior work experience or education is required.
- A minimum of 3 years of relevant experience is typically necessary. Vocational or technical education may be required in addition to prior work experience.
- A high school diploma is preferred.
- At least 1 year of experience in a managed care setting is preferred.
- Bi-lingual proficiency in Spanish is required.
- Experience in health insurance or managed care (Commercial, Medicare, and Medi-Cal) is preferred.
- Experience with community resources and advocacy is preferred.
- Familiarity with practice integration in a triad model of care is preferred.
Compensation
The compensation range for this position is between $20.47 and $28.66 for California.
Additional Information
This compensation range reflects the pay scale for this and other positions at Blue Shield that fall within this pay grade. Salaries are determined based on various factors, including the candidate's experience and current employee salaries for similar roles.
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