Clinical Services Coordinator, Advanced

Your Role

The Care Management team is a member-facing team that provides care coordination to our most vulnerable members to help them overcome barriers, access appropriate services and resources, and improve their overall health and quality of life. The CSC will connect members with needed resources and provide individualized care coordination based on each member’s identified needs and eligibility for services. The Clinical Service Coordinator, Advanced will report to the Manager of Care Management.

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: Support nurse case managers and members with escalated cases involving complex care coordination needs, including claims denials, authorization needs, Continuity of Care (COC) requests, and Access to Care (ATC) needs. Research member eligibility, benefits, claims history, authorization status, provider networks, and case documentation to help identify barriers and support timely resolution. Coordinate with appropriate internal and external partners to support case resolution, including program managers, provider relations, medical directors, provider offices, medical groups, and Blue Shield of California clinical and operational teams. Serve as a liaison between nurse case managers, members, providers, and cross-functional stakeholders to help resolve escalated issues and ensure members are connected to appropriate services and resources. Track escalated case activity, follow up on outstanding items, document updates, and communicate next steps to support timely closure and continuity of care. Demonstrate cultural competence and MI practices while focusing on a member-centered approach when assisting with complex or sensitive member needs.

Qualifications

Your Knowledge and Experience Requires a High School diploma or GED or 1 additional year of relevant experience in lieu of a diploma Requires 5 years of prior relevant experience Desired Certification and/or training as a patient advocate, health coach, care navigator Health insurance/managed care experience (Commercial, IFP, Medicare, and Medi-Cal) Experience with community resources and advocacy Strong interpersonal communication skills and organizational skills 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.