Your Role

The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi-Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement, and care management processes. The CSC will directly help members as their health needs require and will support the Promise Case Managers and/or Social Workers in arranging appropriate follow-up appointments, and other services related to the member's care coordination.

Your Work

In this role, you will:

• Demonstrate cultural competence to work effectively, respectfully, and sensitively within the client's cultural context
• Knowledge of community resources and advocacy
• Incorporation of all Medi-Cal, Cal-AIM and Population Health management requirements with NCQA/HEDIS measures with little to no direct supervision
• Show ability to resolve or direct member FAQs, i.e., plan benefits, coverage, network, preferred facilities, provider searches, claims, authorizations, etc
• Serve as primary point of contact for members and providers
• Deliver administrative and clerical support to the Promise Case Mangers as assigned
• Acts as a liaison to gather information and track all patients referred to the care management program
• Documents all patient specific information in applicable information systems, connecting to other departments as appropriate
• Telephonic communication with members as directed by established and trained protocols to conduct general outreach, health risk assessment (HRA), or other program specific needs
• Manage centralized program toll-free phone lines and email inbox to receive, respond, and triage program inquiries based on eligibility
• Other duties as assigned including, but not limited to, Health Risk Assessment (HRA), assist in coordinating care for Medi-Cal population, generating referrals to appropriate care management program or team to support member needs

Your Knowledge and Experience

• Requires high school diploma or equivalent
• A minimum of 3 years relevant experience
• A minimum of 3 years' combined experience in a clinical practice in the hospital, outpatient, health plan, community health, or care management setting
• A minimum of 1 year experience in a managed care environment.
• Health insurance/ managed care experience (Commercial, Medicare, and Medi-Cal)
• Community resources and advocacy
• Practice integration in a triad model of care
• Bilingual in Spanish preferred

Pay Range:

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