Posted in Other 30+ days ago.
Type: Full Time
Business Unit: Health Care Quality & Affordability
The Health Care Quality and Affordability team is made up of about 1,000 doctors, nurses, pharmacists, strategists, industry experts and innovators with a single vision - to transform the delivery of health care. Every day, we work together to improve the quality of patient care for our members while lowering health Care costs to ensure all Californians have access to the care they deserve.
How do we do it? Through partnership, innovation, and thought leadership.
We continue to expand our network of providers to ensure state-wide access to care. We evaluate analytic and digital health tools that simplify care delivery while improving member health status, health care quality and affordability as well as member and provider experience. We provide high-touch services to members from experienced clinical teams. You'll also find us collaborating with our federal and state legislative officials to help shape policy to advance our Blue Shield mission.
Position Summary:
The clinical services coordinator (CSC) will report directly to the manager of care management and will serve as 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.
Specific Responsibilities Include:
- 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.
- Seeks and accepts referrals for target patient populations, i.e. fragile seniors, catastrophic and transplant cases, frequent utilizer of ER and inpatient services, and patients diagnosed with specific diseases.
- Acts as a liaison, gather information and track all patients referred to the care management programs.
- Assists in coordinating care for specific high risk/high cost patient population, including referrals t 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.
Minimum Education & Experience Requirements:
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A minimum of an associate degree
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A minimum of 5 years' experience in a managed care environment.
Preferred:
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Bachelor's degree in a health-related field
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Certification and/or training as a patient advocate, health coach, care navigator
Knowledge and Skills:
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Health insurance/managed care experience (Commercial, Medicare, and Medi-Cal)
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Community resources and advocacy
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Practice integration in a triad model of care
Additional Information
- Our Company: At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!
- Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
- Equal Employment Opportunity: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.
- Requisition ID: 200023Q
- Posting Date: Sep 25, 2020
- Schedule: Full-time
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State Street
$60,000.00 - $90,000.00 per year
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State Street
$110,000.00 - $177,500.00 per year
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Flagstar Bank, N.A. |