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Clinical Services Coordinator, Intermediate

  • Job
    Full-time
    Mid Level
  • Healthcare
  • San Diego, +2

AI generated summary

  • You need at least 3 years of experience in Utilization Management, knowledge of UM regulatory standards, and prior authorization guidelines. Knowledge of inpatient, DME, and Home Health areas is required.
  • You will process authorizations, data entry, support Case Managers, research member benefits, provide operational support, serve as initial contact for members and providers, review eligibility referrals, process service authorizations, and offer administrative support in a healthcare setting.

Requirements

  • 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.
  • Requires UM regulatory TAT standards
  • Requires basic job knowledge of systems and procedures obtained through prior work experience or education
  • At least 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 knowledge of the prior authorization and/or concurrent review non-clinical business rules and guidelines, preferably within the inpatient, DME and/or Home Health areas related to children

Responsibilities

  • Process faxed/phoned in authorizations, UM/CM requests 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 Advanced/Specialist CSC
  • Assign initial EOA days, or triage to nurses, based on established workflow
  • Research member eligibility/benefits and provider networks
  • Provide operational support to ensure healthcare services are provided to member, employer, and providers
  • Serve as the initial point of contact for members and providers by telephone or correspondence
  • Within extension of authority, review specific CHP eligibility referrals
  • Process service authorization referrals and assist with system letters, requests for information and data entry
  • Provide administrative/clerical support to medical management

FAQs

What is the primary focus of the Children’s Health Program (CHP) team?

The CHP team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within the Promise Clinical Team.

Who does the Clinical Services Coordinator, Intermediate report to?

The Clinical Services Coordinator, Intermediate will report to the CHP Manager.

What are some of the responsibilities of the Clinical Services Coordinator, Intermediate?

Responsibilities include working with clinical staff to support member needs using established Blue Shield Medical Policies and Guidelines, daily inventory management, processing medical records and requests, fax intake, referral intake, and other assigned duties.

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Finance
Industry
5001-10,000
Employees
1939
Founded Year

Mission & Purpose

Blue Shield of California strives to create a healthcare system worthy of its family and friends that is sustainably affordable. Blue Shield of California is a tax-paying, nonprofit, independent member of the Blue Shield Association with 4.7 million members, 7,800 employees, and $22.9 billion in annual revenue. Founded in 1939 in San Francisco and now headquartered in Oakland, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare healthcare service plans in California. Blue Shield of California complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability.