Your Role
The Care Management Department is seeking a dedicated and compassionate Clinical ServiceCoordinator, Specialist to join our team. The Lead Clinical Service Coordinator will report to the Supervisor of Care Operations and will oversee and support the team of Clinical Service Coordinators. You will play a vital role in spearheading outreach and engagement efforts with our members, ensuring high-quality care management services, and conducting thorough assessments to identify member needs. The successful candidate will interact telephonically with members to assist with complex care coordination needs and facilitate connections between members and appropriate services, including internal nurse care managers, vendors, and behavioral health providers.
Your Work
Inthisrole,youwill:
- Supervise and provide guidance to the Clinical Service Coordinators to ensure consistency and quality in member outreach and care management services
- Monitorspecificqueues/workstreamsandgeneratepre-definedreportstoidentifyand resolve common errors
- Conduct daily and monthly huddles/meetings
- Provide support to management, including projects, daily management meetings, training, updates on team performance
- Collaborate with management on new policies, procedures, and guidelines to enhance the effectiveness of coordinators’ workflow. Coordinating with management to organize the department workload and establish work standards to promote efficiency and productivity. Manage coordinators’ dashboard and provide education/training to ensure that coordinators meet goals
- Handlemember/providercall escalations
- Conduct telephonic outreach efforts to engage members and introduce them to care management services
- Complete thorough assessments to identify member needs and care gaps
- Maintain accurate and up-to-date member records and documentation of all interactions and services provided
- Conduct follow-up calls to ensure members’ needs are being met
- Provide members with information and resources about available care management services and how to access them
- Provide administrative/clerical support to medical and disease management programs
- Act as a liaison, gather information, and track all patients referred to the care management programs
- Assist in coordinating care for specific high-risk/high-cost patient populations, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc
- Assist in verifying health plan benefits and coordinating ambulatory services
- Demonstrate cultural competence to work effectively, respectfully, and sensitively within the client’s cultural context
- Assist with precepting responsibilities for new hires and auditing efforts
Your Knowledge and Experience
- Requiresadvancedknowledgewithinaspecificdisciplinetypicallygainedthrough extensive work experience and/or education.
- Requiresminimumof7yearsofpriorrelevantexperience.Mayrequirevocationalor technical education in addition to prior work experience.
- Requiresahighschooldiplomaorequivalent.
- Developsstrategiesalongwithsupervisortoensureteammembersmeetdailyworkload and stays in compliance with daily management system vision board
- Understanding ofbasicmember engagementprinciples,techniquesandpracticesand their application to complex social and clinical problems.
- Health insurance/ managed care experience (Commercial, Medicare, and Medi-Cal)
- Community resources and advocacy
- Ability to identify issues and develop effective solutions to meet members' needs
- Flexibility to adjust to changing circumstances and member needs
- Strong verbal and written communication skills to effectively convey information to members and colleagues
Pay
The pay range for this role is: $ 26.37 to $ 36.92 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.
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