Your Role

The Children's Health Program (CHP) team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team. The Clinical Services Coordinator Intermediate will report to the CHP Manager. In this role you will work with clinical staff to support member needs using the established and approved Blue Shield Medical Policies and Guidelines which align with nationally recognized standards. You will be responsible for working daily inventory, processing medical records and requests, fax intake, referral intake, and other duties as assigned.

Your Work

In this role, you will:

• Process faxed/phoned in authorizations, UM/CM requests and/or calls left on voicemail.
• Select support for Case Manager such as mailings, surveys
• Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation
• Support to Advanced/Specialist CSC
• Assign initial EOA days, or triage to nurses, based on established workflow
• Research member eligibility/benefits and provider networks
• Provide operational support to ensure healthcare services are provided to member, employer, and providers
• Serve as the initial point of contact for members and providers by telephone or correspondence
• Within extension of authority, review specific CHP eligibility referrals
• Process service authorization referrals and assist with system letters, requests for information and data entry
• Provide administrative/clerical support to medical management

Your Knowledge and Experience

• Requires at least 3 years of prior relevant experience
• May require vocational or technical education in addition to prior work experience
• Requires Utilization Management regulatory Turn Around Time standards
• Requires basic job knowledge of systems and procedures obtained through prior work experience or education
• Desires at least 1 year work experience within the Medical Care Solutions Utilization Management Department or a similar medical management department at a different payor, facility, or provider group
• Desires in-depth knowledge of the prior authorization and/or concurrent review non-clinical business rules and guidelines, preferably within the inpatient, DME and/or Home Health areas related to children

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.