Clinical Services Coordinator, Intermediate (Bilingual)

Your Role The Clinical Services Coordinator (CSC) will report directly to the supervisor of care management support operations and will serve as an initial point of contact for providers and members in the medical management process by telephone or correspondence. The CSC will interact telephonically with members as per established protocol or direction to ensure that members are effectively and efficiently managed through the medical/disease management process as needs require and in helping the RN care manager or social worker in arranging appropriate medical equipment (DME), home health, follow-up appointments, and other services related to care coordination.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning. Responsibilities

Your Work In this role, you will: Telephonic outreach to conduct the Health Risk Assessment (HRA) with the member Telephonic outreach to members as directed by protocol or RN care manager or social worker. Assists with system letters, requests for information and data entry. Back up to phones when needed. Provides administrative/clerical support to medical and disease management programs. Acts as a liaison, gathers information, and track all patients referred to the care management programs. Assists in coordinating care for specific high risk/high-cost patient population, including referrals to 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 ambulatory services. Demonstrates cultural competence to work effectively, respectfully, and sensitively within the client’s cultural context. Assists with precepting responsibilities for new hires and auditing efforts. Note: The selected candidate will be asked to come onsite to the Long Beach, CA office 2 times per month Qualifications

Your Knowledge and Experience Requires a High School Diploma or GED or 1 year of additional relevant experience in lieu of a diploma Requires a minimum of 3 years of relevant experience Requires a minimum of 1 year experience in a managed care environment. Bi-Lingual, English/Spanish is required Experience using MS Office applications including Word, Excel, PowerPoint, Outlook and Teams. Experience using Salesforce preferred. Knowledge of clinical workflow to assist nurses with research and issue resolution preferred Health insurance/ managed care experience (Commercial, Medicare, and Medi-Cal) preferred. Knowledge of Medicare eligibility criteria preferred. Experience working with community resources and member advocacy preferred Experience working in an integrated practice in a triad model of care preferred Hybrid Virtual Work This role allows employees to work virtually full-time, however employees will be expected to come to the office based on business need.

About Blue Shield of California As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies. At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience. To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals. Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us! 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 listen and communicate effectively, showing empathy by understanding others' perspectives. Courageous.

We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals. Our Workplace Model We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility: For most teams, this means coming into the office two days per week.

Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.

For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews. 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. Equal Employment Opportunity: 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.