Clinical Services Coordinator, Intermediate

Blue Shield of California • El Dorado, AR

3d

About The Position

Your Role The Behavioral Health Utilization Management team provides utilization management and support for members seeking behavioral health treatment. The BHT Care Coordinator will report to the Supervisor, Operations of Behavioral Health Clinical Operations. In this role you will assist the member, family and/or caregiver, and provider in the treatment and management of BHT services, in consultation with the Board-Certified Behavior Analyst (BCBA).

Requirements

• Requires at least 3 years of prior relevant experience
• Requires a High School diploma or equivalent
• Ability to enter data into the computer and extract information from databases required
• Excellent communication skills with individuals internal and external to BSC including physicians, members, patients, and service providers required
• Ability to assist the member, family and/or caregiver, and provider in the treatment and management of BHT services, in consultation with the Board-Certified Behavior Analyst (BCBA) required

Responsibilities

• Process faxed/phoned in authorization requests, 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, in consultation with the Board-Certified Behavior Analyst (BCBA)
• Support to Advanced/Specialist CSC
• Respond to inquiry calls as needed
• Assign initial EOA days, or triage to clinicians, based on established workflow
• Research member eligibility/benefits and provider networks
• Be responsible for establishing trusting relationships with members while providing person-centered support and services
• Provide members and/or family members with care coordination, generate referrals to contracted ancillary service providers and community agencies in collaboration with the member’s provider
• Document assessments, referrals, and case notes in the electronic case management and tracking systems within the established department guidelines
• Provide telephonic triage and care management assistance to members seeking access to the Behavioral Health Therapy (BHT) benefit
• Follow up efficiently with PCP offices to obtain necessary documents
• Other duties as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees