Hybrid Clinical Quality Coordinator — Intermediate

Blue Shield of CA; Oakland (CA); Hybrid; USD 60,000 - 90,000; Full time

Job summary

Blue Shield of California is seeking an Clinical Quality Coordinator (Intermediate) to support the Clinical Quality Review team. You will request medical records and provider responses to facilitate timely clinical review and quality improvement initiatives.

This hybrid role combines virtual work with occasional office presence and requires clear communication skills, comfort with Microsoft Office and Adobe Acrobat, and a basic understanding of managed care concepts and regulatory standards.

Qualifications

• Requires a High school Diploma or GED or 1 year of additional relevant experience in lieu of a diploma
• Requires 3 years of prior relevant experience
• Strong verbal and written communication skills
• Basic knowledge of PC-based software including Microsoft Suite and Adobe Acrobat
• Basic knowledge of managed care principles and benefit plans per line of business (HMO, PPO, Medicare) preferred
• Basic knowledge of regulatory and accreditation agencies (DMHC, DHCS, CMS, NCQA) preferred

Responsibilities

• Request medical records and responses from providers to facilitate clinical review by CQR staff.

Skills

Verbal communication

Written communication

MS Office

Adobe Acrobat

Managed care basics

Regulatory knowledge

Education

High school diploma or GED

Tools

Microsoft Office

Adobe Acrobat

Job description

Blue Shield of California is seeking an Clinical Quality Coordinator (Intermediate) to support the Clinical Quality Review team. You will request medical records and provider responses to facilitate timely clinical review and quality improvement initiatives.

This hybrid role combines virtual work with occasional office presence and requires clear communication skills, comfort with Microsoft Office and Adobe Acrobat, and a basic understanding of managed care concepts and regulatory standards.