Clinical Services Coordinator, Intermediate

Your Role

A variety of soft skills and experience may be required for the following role Please ensure you check the overview below carefully.

The Medical Care Solutions Federal Employee Program Clinical Support Coordinator team provides Care Management, Prior Authorization, and Utilization Management services to our members. The HEDIS Clinical Support Coordinator will report to the Manager, Non-Clinical Operations. In this role you will be responsible for placing a high-volume of Outreach & Engagement telephone calls encouraging Care Management program participation.  This role will also process Care Management requests including faxes, phone calls, and emails from Hospice Agencies, Residential Treatment Centers, Skilled Nursing Facilities, and more.

Your Work

In this role, you will :

• Complete a large volume of outbound Outreach & Engagement phone calls with an emphasis on successfully connecting with members to discuss Care Gaps and to enroll them into Care Management program offerings.
• Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation
• Support to Advanced / Specialist CSC
• Assign initial EOA days, or triage to nurses, based on established workflow
• Research member eligibility / benefits and provider networks
• Verify member eligibility
• Process hospice, residential treatment center, and skilled nursing facility admits
• Send referrals to Case Management as appropriate
• Other duties as assigned

Your Knowledge and Experience

The pay range for this role is : $ 20.70 to $ 28.98 for California.

Note

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

LI-AG3

Salary : $21 - $29