Jobs
>
Long Beach

    Clinical Services Coordinator, Intermediate - Long Beach, United States - Blue Shield of California

    Blue Shield of California
    Blue Shield of California Long Beach, United States

    3 weeks ago

    Default job background
    Description
    Your Role

    The Children's Health Program (CHP) team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team.

    The Clinical Services Coordinator Intermediate will report to the CHP Manager.

    In this role you will work with clinical staff to support member needs using the established and approved Blue Shield Medical Policies and Guidelines which align with nationally recognized standards.

    You will be responsible for working daily inventory, processing medical records and requests, fax intake, referral intake, and other duties as assigned.

    Your Work

    In this role, you will:
    Process faxed/phoned in authorizations, 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
    Support to Advanced/Specialist CSC
    Assign initial EOA days, or triage to nurses, based on established workflow
    Research member eligibility/benefits and provider networks
    Provide operational support to ensure healthcare services are provided to member, employer, and providers
    Serve as the initial point of contact for members and providers by telephone or correspondence
    Within extension of authority, review specific CHP eligibility referrals
    Process service authorization referrals and assist with system letters, requests for information and data entry
    Provide administrative/clerical support to medical management
    Your Knowledge and ExperienceRequires at least 3 years of prior relevant experienceMay require vocational or technical education in addition to prior work experience Requires Utilization Management regulatory Turn Around Time standards Requires basic job knowledge of systems and procedures obtained through prior work experience or educationDesires at least 1 year work experience within the Medical Care Solutions Utilization Management Department or a similar medical management department at a different payor, facility, or provider groupDesires in-depth knowledge of the prior authorization and/or concurrent review non-clinical business rules and guidelines, preferably within the inpatient, DME and/or Home Health areas related to children

    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.

  • Blue Shield Of California

    Clinical Quality Coordinator, Intermediate

    1 hour ago

    Blue Shield Of California Long Beach, United States

    Your Role · The Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator will report to the Supervisor of the HEDIS Outreach Team. In this role you will be responsible for conducting ...

  • Blue Shield of California

    Clinical Services Coordinator, Intermediate

    1 week ago

    Blue Shield of California Long Beach, United States Professional

    Your Role · The clinical services coordinator (CSC) will report directly to the supervisor of care management support operations and will serves as initial point of contact for providers and members in the medical management process by telephone or correspondence. The CSC will in ...

  • Blue Shield of California

    Clinical Services Coordinator, Intermediate

    1 week ago

    Blue Shield of California Long Beach, United States Professional

    Your Role · The clinical services coordinator (CSC) will report directly to the supervisor of care management support operations and will serves as initial point of contact for providers and members in the medical management process by telephone or correspondence. The CSC will in ...

  • Blue Shield of California

    Clinical Services Coordinator, Intermediate

    3 weeks ago

    Blue Shield of California Long Beach, United States

    The Childrens Health Program (CHP) team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team. The Clinical Services Coordinator Intermediate will report to Clinical, Media, Coordinator, S ...

  • Blue Cross and Blue Shield Association

    Clinical Services Coordinator, Intermediate

    3 weeks ago

    Blue Cross and Blue Shield Association Long Beach, United States

    Your Role · The Children's Health Program (CHP) team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team. The Clinical Services Coordinator Intermediate will report to the CHP Manager. I ...

  • Blue Shield of California

    Clinical Services Coordinator, Intermediate

    3 weeks ago

    Blue Shield of California Long Beach, United States

    Your Role · The Children's Health Program (CHP) team provides identification, referrals, and care management for all Medi-Cal members under 21 years old and collaborates within Promise Clinical Team. The Clinical Services Coordinator Intermediate will report to the CHP Manager. I ...

  • Blue Cross and Blue Shield Association

    Clinical Services Coordinator, Intermediate

    3 weeks ago

    Blue Cross and Blue Shield Association Long Beach, United States

    Your Role · The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi-Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that membe ...

  • Blue Cross and Blue Shield Association

    Clinical Services Coordinator, Intermediate

    2 weeks ago

    Blue Cross and Blue Shield Association Long Beach, United States

    Your Role · The clinical services coordinator (CSC) will report directly to the supervisor of care management support operations and will serves as initial point of contact for providers and members in the medical management process by telephone or correspondence. The CSC will in ...

  • Blue Shield of California

    Clinical Services Coordinator, Intermediate

    2 weeks ago

    Blue Shield of California Long Beach, United States

    The clinical services coordinator (CSC) will report directly to the supervisor of care management support operations and will serves as initial point of contact for providers and members in the medical management process by telephone or correspondenc Coordinator, Clinical, Media, ...

  • Blue Shield of California

    Clinical Services Coordinator, Intermediate

    2 weeks ago

    Blue Shield of California Long Beach, United States

    Job Description · Your Role · The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi-Cal Care Management. This individual will interact telephonically and electronically with members and providers as per established protocol or direction to ...

  • Blue Shield of California

    Clinical Services Coordinator, Intermediate

    1 week ago

    Blue Shield of California Long Beach, United States Professional

    Your Role · The clinical services coordinator (CSC) will report directly to the supervisor of care management support operations and will serves as initial point of contact for providers and members in the medical management process by telephone or correspondence. The CSC will in ...

  • Blue Shield of California

    Clinical Services Coordinator, Intermediate

    2 weeks ago

    Blue Shield of California Long Beach, United States

    Job Description · Your Role · The clinical services coordinator (CSC) will report directly to the supervisor of care management support operations and will serves as initial point of contact for providers and members in the medical management process by telephone or correspondenc ...

  • Blue Shield Of California

    Clinical Quality Coordinator, Intermediate

    2 days ago

    Blue Shield Of California Long Beach, United States

    Job DescriptionYour RoleThe Clinical Quality team oversees and is responsible of HEDIS medical record review, pursuit, and overall HEDIS submission. The Clinical Quality Coordinator will report to the Supervisor of the HEDIS Outreach Team. In this role you will be responsible for ...

  • Blue Shield of California

    Regulatory Complaint Coordinator, Intermediate

    12 hours ago

    Blue Shield of California Long Beach, United States

    **Your Role · The Appeals and Grievance Department Regulatory team is responsible for responding to inquiries received directly from our state regulatory agencies. The Regulatory Complaint Coordinator, Intermediate, will report to the Regulatory Complaint Supervisor. In this role ...

  • Molina Healthcare

    Specialist, Provider Network Admin

    3 weeks ago

    Molina Healthcare Long Beach, United States

    Job Summary · Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system requirements of internal customers as it pertai ...

  • Molina Healthcare

    Specialist, Provider Network Admin

    3 weeks ago

    Molina Healthcare Long Beach, United States

    **Remote and must live in Wisconsin** · Job Summary · Provider Network Administration is responsible for the accurate and timely validation and maintenance of critical provider information on all claims and provider databases. Staff ensure adherence to business and system require ...

  • SCAN Group

    IT Project Coordinator Intern

    3 weeks ago

    SCAN Group Long Beach, United States

    **About SCAN** · **The Job** · Looking for a highly motivated self-starter who can thrive under general direction and guidance. Responsible for supporting all project management and coordination aspects of assigned projects. Collaborates with Project Managers, Project Leaders, an ...

  • Roux

    Project Geologist

    1 week ago

    Roux Long Beach, United States

    **Job Description**: · **Position Overview** · This position will design and implement appropriate technical services to ensure that client and project management needs are met. Position includes performing field and office tasks as well as providing project management support fo ...

  • TekWissenLLC

    Safety Analyst

    1 week ago

    TekWissenLLC Long Beach, United States

    This position supports the client Vehicle Processing & Distribution Center (VDC) Safety and Environmental program requirements. · - Activities include but are not limited to: · - Identify, anticipate, and act upon safety and environmental concerns, hazards, exposures, and unsafe ...

  • TekWissenLLC

    Safety Analyst

    1 week ago

    TekWissenLLC Long Beach, United States

    This position supports the client Vehicle Processing & Distribution Center (VDC) Safety and Environmental program requirements. · - Activities include but are not limited to: · - Identify, anticipate, and act upon safety and environmental concerns, hazards, exposures, and unsafe ...