Clinical Services Coordinator, Intermediate (Bilingual)

Blue Shield of CA; Long Beach (CA); Hybrid; USD 60,000 - 85,000; Full time

Job summary

Blue Shield of CA in Long Beach, CA is looking for a Clinical Services Coordinator to serve as the primary contact for providers and members in the medical management process. You will help arrange DME, home health, and follow-up appointments, supporting the RN care manager and social worker in coordination of care.

The role emphasizes a hybrid virtual work model with occasional in-office work as needed, and it requires bilingual English/Spanish communication and prior managed care experience.

Qualifications

• Requires a High School Diploma or GED or 1 year of additional relevant experience in lieu of a diploma.
• Requires a minimum of 3 years of relevant experience.
• Requires a minimum of 1 year experience in a managed care environment.
• Bi-Lingual, English/Spanish is required.
• Experience using MS Office applications including Word, Excel, PowerPoint, Outlook and Teams. Experience using Salesforce preferred.
• Knowledge of clinical workflow to assist nurses with research and issue resolution preferred.
• Health insurance/ managed care experience (Commercial, Medicare, and Medi-Cal) preferred. Knowledge of Medicare eligibility criteria preferred.
• Experience working with community resources and member advocacy preferred.
• Experience working in an integrated practice in a triad model of care preferred.

Responsibilities

• Serve as initial point of contact for providers and members in the medical management process by telephone or correspondence.
• Assist RN care manager or social worker in arranging appropriate medical equipment (DME), home health, follow-up appointments, and other care coordination services.
• Support leaders and teams by contributing to effective care management and problem resolution.

Skills

Bilingual (English/Spanish)

MS Office Suite

Care coordination

Member advocacy

Community resources

Education

High School Diploma or GED

1 year alternative experience

Tools

Salesforce

Job description

Your Role

The Clinical Services Coordinator (CSC) will report directly to the supervisor of care management support operations and will serve as an 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 (DME), home health, follow-up appointments, and other services related to care coordination.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Knowledge and Experience

• Requires a High School Diploma or GED or 1 year of additional relevant experience in lieu of a diploma
• Requires a minimum of 3 years of relevant experience
• Requires a minimum of 1 year experience in a managed care environment.
• Bi-Lingual, English/Spanish is required
• Experience using MS Office applications including Word, Excel, PowerPoint, Outlook and Teams. Experience using Salesforce preferred.
• Knowledge of clinical workflow to assist nurses with research and issue resolution preferred
• Health insurance/ managed care experience (Commercial, Medicare, and Medi-Cal) preferred. Knowledge of Medicare eligibility criteria preferred.
• Experience working with community resources and member advocacy preferred
• Experience working in an integrated practice in a triad model of care preferred

Hybrid Virtual Work

This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.