Your Role
The Care Management team is a member facing team that provides care coordination to our most vulnerable members to improve the health equity and quality for each person we serve. The Clinical Service Coordinator, Advanced will report to the Supervisor of Operations, Care Management. In this role you will serve 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 coordinate member’s social determinant of health needs. The CSC will assist members with linking them to resources that are needed and provide care coordination that is individualized for each member identify for services. The main goal of this team is to link members to the services they need to improve their health equity and health quality.
Your Work
In this role, you will:
- Process faxed/phoned in authorizations, UM/CM requests, special processing/case types and/or calls left on voicemail
- Monitor specific queues/workstreams and generates pre-defined reports to identify and resolve common errors
- Handle customer/provider problematic calls
- Check member history for case management triage and research member eligibility/benefits and provider networks
- Demonstrates cultural competence to work effectively, respectfully, and sensitively within the client's cultural context
- Seeks and accepts referrals for target patient populations, i.e. fragile seniors, catastrophic and transplant cases, frequent utilizer of ER and inpatient services, and patients diagnosed with specific diseases
- Acts as a liaison, gather information and track all patients referred to the care management programs and community resource referrals
- Assists in coordinating care for specific high risk/high cost patient population, including referrals t community resources, facilitation of medical services, referral to ancillary providers, etc.
Your Knowledge and Experience
- Requires a high school diploma or equivalent
- Requires at least 5 years of prior relevant experience
- Desired Certification and/or training as a patient advocate, health coach, care navigator
- Health insurance/managed care experience (Commercial, IFP, Medicare, and Medi-Cal)
- Community resources and advocacy
- Practice integration in a triad model of care
Pay
The pay range for this role is: $ 23.83 to $ 33.36 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.
