Clinical Services Coordinator, Intermediate at Blue Shield of CA in San Francisco, California

Job Description:

Job Summary

Clinical Servicesprovides operational support to ensure healthcare services are provided to meet member, employer, and provider needs. In this position you will work from home until Covid restrictions are lifted.

Responsibilities

• Serves as initial point of contact for providers and members in the medical management process by telephone or correspondence


• Assists in ensuring members are effectively and efficiently managed through the medical/disease management process as needs require. Within extension of authority, assigns length of stay on acute inpatient admissions, as well as approves specific home health, DME


• Process authorization requests and facilitates referrals. Assists with system letters, re quests for information and data entry


• Provides administrative/clerical support to medical and disease management. Essential Responsibilities: Intake (faxed in authorizations, 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


• Support to Senior/Lead HCS


• Responds to inquiry calls on a limited basis. Assign initial EOA days. Advance cases to senior staff. Research networks.


• Other duties as assigned

Knowledge and Experience

• Requires basic job knowledge of systems and procedures obtained through prior work experience or education


• Typically, requires minimum of 3 years of experience


• May require vocational or technical education in addition to prior work experience

Highly Preferred

• Long term care experience


• Acute inpatient admissions experience


• Able to work under high stress


• Follow and manageregulatory turn around times.


• Available to work overtime on Saturdays as needed


• Strong written and verbal communications skills

Additional Information

• About 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.
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• EEO Footer: 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: 21001LF













• Posting Date: May 4, 2021











• Schedule: Full-time

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