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Social Services Representative, Advanced

Company: Blue Shield of California
Location: San Diego
Posted on: September 23, 2022

Job Description:

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to DE&I combines a focus on our people processes and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen. Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in - join us! Your Role The Social Services Coordinator provides telephonic social services support and resource referrals to Blue Shield Promise members, in addition to administrative support to the social service team and Manager/Supervisor. The Social Services Coordinator is regularly reaching out to members and/or family members with the goal of assessing for social service needs, and coordinating support aimed towards improving member quality of care. The Social Services Coordinator coordinates with team members and other internal departments, as well as provides the first line of telephonic response for incoming calls to the Social Services department. Your Work In this role, you will: Be responsible for establishing trusting relationships with members while providing person-centered support and services
Conduct telephonic social determinants of health needs assessment with moderate acuity members to address social barriers and care gaps
Provide members and/or family members with care coordination, referrals and linkage to Health Plan resources and community agencies
Document assessments, referrals and case notes in the electronic case management and tracking systems within the established department guidelines
File and make necessary follow-up on mandated reporting, e.g. Adult Protective Services, Child Protective Services, etc.
Provide telephonic support to member and/ or family members following their discharges from hospitals and other medical facilities.
Coordinates services with State and community programs on behalf of the member, particularly when the member is unable to effectively do so independently.
Prepares logs and reports as needed for meetings and audits
Any other assigned duties Your Knowledge and Experience Requires a High School diploma or equivalent
Bachelor's degree preferred
Requires at least 5 or more years of prior relevant experience
Requires at least 2 years of prior relevant experience with a Medi-Cal Managed Health Plan
Medi-Cal (Medicaid)/Medicare Experience
Required experience with managing electronic health records and documenting in clinical case management systems
Required excellent communication skills both orally and in writing with all levels of BSC Promise staff, members, contracted physicians, participating provider groups, and community-based organizations
Required effective time management skills and ability to define and act on priorities efficiently
Desired knowledge of governmental and private organizations, resources in the community, laws, regulations, and policies
Experience working with or for a managed health care plan Our Values Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Keywords: Blue Shield of California, San Diego , Social Services Representative, Advanced, Sales , San Diego, California

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