Clinical Services Coordinator, Care Management

At Blue Shield of California we are parents, leader, students, visionaries, heroes, and providers. Everyday we come together striving to fulfill our mission, to ensure all Californians have access to high-quality health care at a sustainably affordable price. For more than 80 years, Blue Shield of California has been dedicated to transforming health care by making it more accessible, cost-effective, and customer-centric. We are a not-for-profit, independent member of the Blue Cross Blue Shield Association with 6,800 employees, more than $20 billion in annual revenue and 4.3 million members. The company has contributed more than $500 million to Blue Shield of California Foundation since 2002 to have a positive impact on California communities. Blue Shield of California is headquartered in Oakland, California with 18 additional locations including Sacramento, Los Angeles, and San Diego. We're excited to share Blue Shield of California has received awards and recognition for - LGBT diversity, quality improvement, most influential women in corporate America, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we're striving to make a positive change across our industry and the communities we live in - Join us!

Description

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 truly 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 comprehensive approach to DE&I combines a focus on our people processes and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in - join us!

Your Role

The Clinical Services Coordinator (CSC) will report directly to the Manager of Care Management and will serve as the initial point of contact for the Maternity Program. The CSC will interact telephonically and electronically with members and providers as per established protocol or direction to ensure that members are effectively and efficiently managed through the outreach, engagement, and care management processes. The CSC will directly help members as their maternal health needs require and will support the Maternity Care Managers and/or Maternity Social Workers in arranging appropriate follow-up appointments, and other services related to the member's care coordination.

Your Work

In this role, you will:
  • Prepare patients for examination by recording medical history and confirming purpose of visit
  • Perform preliminary tests, blood pressure, weight, and temperature
  • Maintain patient lab tests and x-rays
  • Maintain medical supply inventory, logs and properly rotates inventory for cost control
  • Promote and maintain and ensure a safe, secure, and healthy work environment by following standards and procedures and complying with legal regulations
  • Primary point of contact for member and provider support for the Maternity care management program.
  • Telephonic outreach to members as directed by protocol
  • Manage centralized program toll-free number and email mailbox. Receive, respond, and triage program inquiries as appropriate
  • Awareness of enterprise maternal health priorities and community initiatives and how they may impact Maternity care management program
  • Knowledge of county specific requirements and services, employer-specific benefits, external partners and be able to understand their impact on the Maternity care management program
  • Ability to resolve or direct member FAQs, i.e., plan benefits, coverage, network, preferred facilities, provider searches, claims, authorizations, etc
  • Connect members to resources, ie, online resources, educational materials, local services
  • Help members access coverage and care for fertility, contraception, and other maternity-related treatment plans
  • Coordinate and communicate support for OOS members
  • Assists with system letters, fulfillment, and other requests for information and data entry.
  • Back up to phones when needed
  • Provides administrative/clerical support to the Maternity Program
  • Seeks and accepts referrals for target patient populations
  • Acts as a liaison, gather information and track all patients referred to the Maternity care management program
  • Assists in coordinating care for specific patient populations, including referrals for community resources, facilitation of medical services, referral to ancillary providers, etc
  • Documents all patient specific information in appropriate information systems
  • Assists in verifying health plan benefits and coordinating care coordination services
  • Experience and interest in Maternity, Women's & Children's Health, Perinatal, Postpartum, Obstetrics, High-Risk Obstetrics, NICU, or other related specialties
  • Demonstrates cultural competence to work effectively, respectfully, and sensitively within the client's cultural context


Qualifications

Your Knowledge and Experience
  • Requires a high school diploma or equivalent
  • Requires at least 3 years of prior relevant experience
  • A minimum of 3 years' combined experience in a clinical practice in the hospital, outpatient, health plan, community health, or other related managed care setting
  • Health insurance/managed care experience (Commercial and Medi-Cal)


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.


Physical Requirements

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.


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.EEO Policy