Clinical Services Coordinator, Intermediate (Bilingual)

Blue Shield of California•Long Beach, CA

About The Position

Your Role The clinical services coordinator (CSC) will report directly to the supervisor of care management support operations and will serve as an 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 direction to ensure that members are effectively and efficiently managed through the medical/disease management process as needs require and in helping the RN care manager or social worker in arranging appropriate medical equipment (DME), home health, follow-up appointments, and other services related to care coordination. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Responsibilities Your Work In this role, you will:

Requirements

A minimum of a high school diploma or equivalent is required
A minimum of 3 years of relevant experience is required
Bilingual, English/Spanish is required
Experience using MS Office applications including Word, Excel, PowerPoint, Outlook and Teams

Nice To Haves

Experience using Salesforce preferred
Knowledge of clinical workflow to assist nurses with research and issue resolution preferred
Health insurance/ managed care experience (Commercial, Medicare, and Medi-Cal) preferred
Knowledge of Medicare eligibility criteria preferred
Experience working with community resources and member advocacy preferred
Experience working in an integrated practice in a triad model of care preferred

Responsibilities

Telephonic outreach to conduct the Health Risk Assessment (HRA) with the member
Telephonic outreach to members as directed by protocol or RN care manager or social worker
Assists with system letters, requests for information and data entry
Back up to phones when needed
Provides administrative/clerical support to medical and disease management programs
Acts as a liaison, gathers information, and tracks all patients referred to the care management programs
Assists in coordinating care for specific high risk/high-cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc.
Documents all patient specific information in appropriate information systems
Assists in verifying health plan benefits and coordinating ambulatory services
Demonstrates cultural competence to work effectively, respectfully, and sensitively within the client’s cultural context
Assists with precepting responsibilities for new hires and auditing efforts