- 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
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Clinical Services Coordinator, Intermediate
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Clinical Services Coordinator, Intermediate
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Clinical Services Coordinator, Intermediate
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Clinical Services Coordinator, Intermediate
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Clinical Services Coordinator, Intermediate
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Clinical Services Coordinator, Intermediate
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Clinical Services Coordinator, Intermediate
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Clinical Services Coordinator, Intermediate
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Blue Shield of California Long Beach, United StatesJob 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 ...
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Clinical Services Coordinator, Intermediate - Long Beach, United States - Blue Cross and Blue Shield Association
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.
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 WorkIn this role, you will: