What are the responsibilities and job description for the Clinical Services Coordinator, Intermediate position at Blue Shield of CA?
Your Role
The MCS Clinical Service Intake team responsible for timely and accurate processing of Treatment Authorization Requests. The Clinical Services Coordinator (CSC), Intermediate will report to the Supervisor of Clinical Services Intake . In this role you will be for supporting clinical staff day to day operations for Promise (Medi-Cal) or Commercial/Medicare lines of business.
Your Knowledge and Experience
- Requires a high school diploma or equivalent
- Requires at least 3 years of prior relevant experience
- May require vocational or technical education in addition to prior work experience
- 1-year work experience within the Medical Care Solutions' Utilization Management Department or a similar medical management department at a different payor, facility, or provider/group.
- In-depth working knowledge of the prior authorization and/or concurrent review non-clinical business rules and guidelines, preferably within the Outpatient, Inpatient, DME and/or Home Health, Long Term Care and CBAS areas
- In-depth working knowledge of the systems/tools utilized for UM authorization functions such as AuthAccel, Facets, PA Matrix or other systems at a different payor, facility, or provider/group.
- Ability to provide both written and verbal detailed prior authorization workflow instructions to offshore staff.
- Ability to work in a high-paced production environment with occasional overtime needed (including weekends) to ensure regulatory turnaround standards are met.
- Knowledge of UM regulatory Turn Around Time (TAT) standards
- Knowledge of clinical workflow to assist nurses with case creation, research/issue resolution and other UM related functions, as necessary.
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.
