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Medical and Health Services Coordinator

Company: Blue Shield of California
Location: San Diego
Posted on: June 8, 2024

Job Description:

Your Role
The clinical services coordinator (CSC) will report directly to the supervisor of care management support operations and will serves as initial point of contact for providers and members in the medical management process by telephone or correspondence. The CSC will interact telephonically with members as per established protocol or direction to ensure that members are effectively and efficiently managed through the medical/disease management process as needs require and in helping the RN care manager or social worker in arranging appropriate medical equipment durable medical equipment (DME), home health, follow-up appointments, and other services related to care coordination. -
Your Work
In this role, you will:
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 -
Your Knowledge and Experience
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. -
Bi-Lingual in Spanish preferred
Health insurance/ managed care experience (Commercial, Medicare, and Medi-Cal)
Community resources and advocacy
Practice integration in a triad model of care

Pay Range:
The pay range for this role is: $ 20.47 to $ 28.66 for California.
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.


Keywords: Blue Shield of California, San Diego , Medical and Health Services Coordinator, Healthcare , San Diego, California

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