Hybrid Clinical Quality Coordinator, Intermediate

Blue Shield of CA; Springfield Meadows (CA); Hybrid; USD 65,000 - 75,000; Full time

Job summary

Blue Shield of California seeks a Clinical Quality Coordinator, Intermediate, to support the Clinical Quality Review team by requesting medical records and coordinating reviews with providers.

This hybrid role requires a High School Diploma or GED and 3 years of relevant experience, along with strong communication skills and familiarity with managed care concepts. Hybrid remote work is allowed with occasional in-office requirements.

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

• The Clinical Quality Coordinator will request medical records and responses from providers to facilitate clinical review by CQR staff.

Skills

Verbal and written communication

High school diploma or GED

3 years of relevant experience

Education

High School Diploma or GED

Tools

Microsoft Office

Adobe Acrobat

Job description

Blue Shield of California seeks a Clinical Quality Coordinator, Intermediate, to support the Clinical Quality Review team by requesting medical records and coordinating reviews with providers.

This hybrid role requires a High School Diploma or GED and 3 years of relevant experience, along with strong communication skills and familiarity with managed care concepts. Hybrid remote work is allowed with occasional in-office requirements.