Blue Shield of California

Your Role

The Clinical Services Coordinator (CSC) will report directly to the Supervisor of Promise Medi-Cal Care Management. This individual 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 health needs require and will support the Promise Case Managers and/or 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:

• Demonstrate cultural competence to work effectively, respectfully, and sensitively within the client’s cultural context
• Knowledge of community resources and advocacy
• Incorporation of all Medi-Cal, Cal-AIM and Population Health management requirements with NCQA/HEDIS measures with little to no direct supervision 
• Show ability to resolve or direct member FAQs, i.e., plan benefits, coverage, network, preferred facilities, provider searches, claims, authorizations, etc
• Serve as primary point of contact for members and providers
• Deliver administrative and clerical support to the Promise Case Mangers as assigned
• Acts as a liaison to gather information and track all patients referred to the care management program
• Documents all patient specific information in applicable information systems, connecting to other departments as appropriate
• Telephonic communication with members as directed by established and trained protocols to conduct general outreach, health risk assessment (HRA), or other program specific needs 
• Manage centralized program toll-free phone lines and email inbox to receive, respond, and triage program inquiries based on eligibility
• Other duties as assigned including, but not limited to, Health Risk Assessment (HRA), assist in coordinating care for Medi-Cal population, generating referrals to appropriate care management program or team to support member needs

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 genuinely 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 continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California’s top companies in volunteering and giving. 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 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.

Our Workplace Model:

Blue Shield of California is dedicated to making work-life balance a reality. Whether you prefer to work in an office or from home, we understand flexibility is more important than ever. That’s why Blue Shield is a hybrid company, offering you the opportunity to decide where you can do your best and most meaningful work.

Two ways of working: Hybrid (our default) and office

• Hybrid – In a business unit approved office a few times per year to 3 days per week, on average
• Office – In a business unit approved office 4+ days a week, on average. If the role you’re applying for is deemed an “Essential Role,” the company has determined that the role can only be performed in a Blue Shield office or in the field and would require your to meet the office worker classification.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Due to the current public health emergency in California, Blue Shield employees are almost all working remotely. 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.