Clinical Services Coordinator, Advanced

Blue Shield of California • Long Beach, CA

2d • Remote

About The Position

The Care Management team provides member-facing care coordination to vulnerable members, helping them overcome barriers, access appropriate services and resources, and improve their health and quality of life. The Clinical Services Coordinator connects members with needed resources and provides individualized care coordination based on their identified needs and eligibility for services. The Advanced role supports nurse case managers and members with escalated cases involving complex care coordination needs, and reports to the Manager of Care Management. The position uses a member-centered approach, cultural competence, and motivational interviewing practices when assisting with complex or sensitive needs.

The role allows employees to work virtually full-time, with office attendance based on business need.

Requirements

• High school diploma or GED, or one additional year of relevant experience in lieu of a diploma.
• Five years of prior relevant experience.
• Strong interpersonal communication skills.
• Strong organizational skills.

Nice To Haves

• Certification and/or training as a patient advocate, health coach, or care navigator.
• Health insurance or managed care experience, including Commercial, IFP, Medicare, or Medi-Cal.
• Experience with community resources and advocacy.

Responsibilities

• Support nurse case managers and members with escalated cases involving complex care coordination needs, including claims denials, authorization needs, Continuity of Care requests, and Access to Care 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.
• 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.
• Use cultural competence and motivational interviewing practices while providing member-centered assistance with complex or sensitive needs.

What This Job Offers

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