Clinical Services Coordinator, Advanced

Blue Shield of California • Long Beach, CA

2d • $28 - $39 • Remote

About The Position

The Care Management team provides care coordination to vulnerable members to help them overcome barriers, access appropriate services and resources, and improve their health and quality of life. The Clinical Services Coordinator, Advanced connects members with needed resources and provides individualized care coordination based on identified needs and eligibility for services. The role supports nurse case managers and members with escalated cases involving complex care coordination needs, investigates and coordinates solutions with internal and external partners, and tracks cases through resolution. The position reports to the Manager of Care Management.

This role allows employees to work virtually full-time, with office attendance as needed for business needs. The position is member-facing and calls for a member-centered approach, cultural competence, and motivational interviewing practices when assisting members with complex or sensitive needs.

Requirements

• High school diploma or GED, or one additional year of relevant experience in lieu of a diploma.
• Five years of prior relevant experience.
• Experience with health insurance or managed care, including Commercial, IFP, Medicare, and Medi-Cal.
• Experience with community resources and advocacy.
• Strong interpersonal communication and organizational skills.

Nice To Haves

• Certification and/or training as a patient advocate, health coach, or care navigator.

Responsibilities

• Support nurse case managers and members with escalated cases involving complex care coordination needs, including claims denials, authorization needs, Continuity of Care (COC) requests, and Access to Care (ATC) needs.
• Research member eligibility, benefits, claims history, authorization status, provider networks, and case documentation to identify barriers and support timely resolution.
• Coordinate with internal and external partners, including program managers, provider relations, medical directors, provider offices, medical groups, and Blue Shield of California clinical and operational teams, to support case resolution.
• Serve as a liaison between nurse case managers, members, providers, and cross-functional stakeholders to resolve escalated issues and connect members with appropriate services and resources.
• Track escalated case activity, follow up on outstanding items, document updates, and communicate next steps to support timely closure and continuity of care.
• Demonstrate cultural competence and motivational interviewing practices while taking a member-centered approach to complex or sensitive member needs.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED