Clinical Services Coordinator, Intermediate

Company: Blue Shield of California
Location: Rancho Cordova
Posted on: March 7, 2025

Job Description:

Your Role
The MCS Clinical Service Intake -team responsible for timely and accurate processing of Treatment Authorization Requests. The Clinical Services Coordinator (CSC), Intermediate will report to the Supervisor of Clinical Services Intake -. In this role you will be for supporting clinical staff day to day operations for Promise (Medi-Cal) or Commercial/Medicare lines of business.Your Work
In this role, you will:

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• Work in a production-based environment with defined production and quality metrics.
  
• Process Faxed /Web Portal /Phoned in Prior Authorization or Hospital Admission Notification Requests, Utilization Management (UM)/Case Management (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 Extension Of Authority (EOA) days, or triage to nurses, based on established workflow. -
  
• Research member eligibility/benefits and provider networks. -
  
• Serves as initial point of contact for providers and members in the medical management process by telephone or correspondence.
  
• -Assists with system letters, requests for information and data entry.
  
• Provides administrative/clerical support to medical management.
  
• Intake (received via fax, phone, or portal). Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.
  
• Provide workflow guidance to offshore representative. - - - - - - - - - - - - - - - - - - - - - - - - - -
  
• Other duties as assigned. - - -
  
  - - -Your Knowledge and Experience
  
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  • Requires a high school diploma or equivalent
    
  • Requires at least 3 years of prior relevant experience
    
  • May require vocational or technical education in addition to prior work experience
    
  • 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/group.
    
  • In-depth working knowledge of the prior authorization and/or concurrent review non-clinical business rules and guidelines, preferably within the Outpatient, Inpatient, DME and/or Home Health, Long Term Care and CBAS areas
    
  • In-depth working knowledge of the systems/tools utilized for UM authorization functions such as AuthAccel, Facets, PA Matrix or other systems at a different payor, facility, or provider/group.
    
  • Ability to provide both written and verbal detailed prior authorization workflow instructions to offshore staff. - - - - - - -
    
  • Ability to work in a high-paced production environment with occasional overtime needed (including weekends) to ensure regulatory turnaround standards are met. -
    
  • Knowledge of UM regulatory Turn Around Time (TAT) standards - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
    
  • Knowledge of clinical workflow to assist nurses with case creation, research/issue resolution and other UM related functions, as necessary. - -
    

Keywords: Blue Shield of California, Rancho Cordova , Clinical Services Coordinator, Intermediate, Healthcare , Rancho Cordova, California