Clinical Services Coordinator, Intermediate

JOB DESCRIPTION
Your Role

The Behavioral Health Utilization Management team provides utilization management and support for member seeking behavioral health treatment. The Clinical Services Coordinator will report to the Manager of Behavioral Health Utilization Management. In this role you will assist the member, family and/or caregiver, and provider in the treatment and management of Behavioral Health services, in consultation with the Board Certified Behavior Analyst (BCBA).

Your Work

In this role, you will:

• Process faxed/phoned in authorization requests, 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, in consultation with the Board Certified Behavior Analyst (BCBA).
• Support to Advanced/Specialist CSC
• Assign initial EOA days, or triage to clinicians, based on established workflow
• Research member eligibility/benefits and provider networks
• Be responsible for establishing trusting relationships with members while providing person-centered support and services
• Provide members and/or family members with care coordination, generate referrals to contracted ancillary service providers and community agencies in collaboration with the member’s provider
• Document assessments, referrals, and case notes in the electronic case management and tracking systems within the established department guidelines
• Provide telephonic triage and care management assistance to members seeking access to the Behavioral Health Therapy (BHT) benefit
• Follow up efficiently with PCP offices to obtain necessary documents

QUALIFICATIONS
Your Knowledge and Experience

• Requires at least 3 years of prior relevant experience
• Requires a High School diploma or equivalent
• Bilingual in Spanish preferred
• Ability to enter data into the computer and extract information from databases required
• Excellent communication skills with individuals internal and external to BSC including physicians, members, patients, and service providers required
• Ability to assist the member, family and/or caregiver, and provider in the treatment and management of BHT services, in consultation with the Board Certified Behavior Analyst (BCBA) required

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.

ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. 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 fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving. 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 be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• 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:

Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.

Two ways of working: Hybrid (our default) and office

• Hybrid – In a business unit approved office a few times per year to 3 days per week, on average

• Office – In a business unit approved office 4+ days a week, on average. If the role you’re applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

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.