Clinical Services Coordinator, Specialist (Specialty)

Blue Shield of California; California (MO); Hybrid; USD 80,000 - 95,000; Full time

Job summary

Join a leading healthcare provider as a Clinical Services Coordinator, Specialist focused on managing continuity of care in a fast-paced environment. The role offers a hybrid workplace model, allowing for flexibility while focusing on operational support and team leadership. Ideal candidates will possess significant clinical experience and a passion for enhancing service delivery.

Qualifications

• Requires at least 7 years of relevant experience in clinical services.
• Experience working for a health plan (2 years minimum).
• Ability to train and coach staff effectively.

Responsibilities

• Be a resource and educator for the team.
• Handle customer/provider problematic calls.
• Assist with process and system-related issues.

Skills

Critical Thinking

Training and Coaching

Problem-solving

Education

High School Diploma

Job description

Clinical Services Coordinator, Specialist (Specialty)

Join to apply for the Clinical Services Coordinator, Specialist (Specialty) role at Blue Shield of California

Clinical Services Coordinator, Specialist (Specialty)

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Join to apply for the Clinical Services Coordinator, Specialist (Specialty) role at Blue Shield of California

Your Role

The Behavioral Health Specialty team manages continuity of care, exception requests, and provides support for the clinical Utilization Management team. The Clinical Service Coordinator, Specialist will report to the Manager, Operations BH Specialty Services. In this role you will be the team Lead, providing training and operations support to other Clinical Services Coordinators, assist with production monitoring, and represent the BH Specialty Team as the subject matter expert (SME) in cross-functional meetings.

Job Description

Your Role

The Behavioral Health Specialty team manages continuity of care, exception requests, and provides support for the clinical Utilization Management team. The Clinical Service Coordinator, Specialist will report to the Manager, Operations BH Specialty Services. In this role you will be the team Lead, providing training and operations support to other Clinical Services Coordinators, assist with production monitoring, and represent the BH Specialty Team as the subject matter expert (SME) in cross-functional meetings.

Responsibilities

Your Work

• Be a resource and educator for the team
• Handle customer/provider problematic calls
• Precept new hires
• Assist with process and system related issues and develop and implement solutions
• Intervene when precepting becomes problematic for Advanced Clinical Services Coordinator
• Represent the BH Specialty Team as a SME in cross-departmental meetings
• Identify documentation/process updates and coordinate updates with the document writers
• Assist the Manager with day-to-day operations and caseload monitoring
  
  

Qualifications

Your Knowledge and Experience

• Requires at least 7 years of prior relevant experience
• Requires at least a high school diploma
• At least 2 years of experience working for Health Plan
• Requires a deep understanding of multiple processes and ability to think critically
• Requires the ability to train and coach staff
• Requires the ability to work independently and make decisions quickly and effectively
  
  

About The Team

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield isa U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

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 listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
  
  

Our Workplace Model:

At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working:

• Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:
• Member-facing and approved out-of-state roles remain remote.
• Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
• On-Site: Work from a business unit-approved office an average of four (4) or more days a week.
  
  

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Insurance

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