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Clinical Services Coordinator, Intermediate (Bilingual)

  • Job
    Full-time
    Mid Level
  • Healthcare
  • Long Beach, +2

AI generated summary

  • You must have a high school diploma, 3 years of relevant experience, 1 year in managed care, be bilingual in Spanish, knowledgeable in health insurance, community resources, and practice integration.
  • You will be conducting Health Risk Assessments and telephonic outreach, providing administrative support, coordinating care for high-risk patients, verifying benefits, and demonstrating cultural competence while working with clients.

Requirements

  • A minimum of a high school diploma
  • A minimum of 3 years of relevant experience
  • A minimum of 1 year experience in a managed care environment.
  • Bilingual in Spanish required
  • Health insurance/ managed care experience (Commercial, Medicare, and Medi-Cal)
  • Community resources and advocacy
  • Practice integration in a triad model of care

Responsibilities

  • Telephonic outreach to conduct the Health Risk Assessment (HRA) with the member
  • 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.
  • 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 to 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.

FAQs

What is the primary role of the Clinical Services Coordinator?

The primary role of the Clinical Services Coordinator is to serve as the initial point of contact for providers and members in the medical management process by telephone or correspondence.

Who does the Clinical Services Coordinator report to?

The Clinical Services Coordinator reports directly to the supervisor of care management support operations.

What tasks does the Clinical Services Coordinator perform for members?

The Clinical Services Coordinator interacts telephonically with members to ensure they are effectively and efficiently managed through the medical/disease management process, arranges appropriate medical equipment, home health, follow-up appointments, and other services related to care coordination.

What skills are required for the Clinical Services Coordinator position?

The Clinical Services Coordinator should have strong communication skills, be bilingual in both English and another language, have knowledge of medical terminology, and be able to effectively coordinate care for members.

How does the Clinical Services Coordinator assist the RN care manager or social worker?

The Clinical Services Coordinator helps the RN care manager or social worker in arranging appropriate medical equipment, home health, follow-up appointments, and other services related to care coordination for members.

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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.