Join Blue Shield of California as a Clinical Services Coordinator, Advanced, where you'll play a vital role in supporting the clinical team by ensuring timely reviews of facility compliance claims. Your responsibilities will include processing authorizations, managing queues, and providing clerical support to enhance operational efficiency.
Key Responsibilities
Process faxed/phoned in authorizations, UM/CM requests
Monitor specific queues/workstreams and generate pre-defined reports
Handle customer/provider problematic calls
Check member history for case management triage
Assign initial EOA days or triage to nurses
Assist with system letters, requests for information and data entry
Monitor for Medical Records Outstanding (MRO)
Provide administrative/clerical support to the FCR team
Act as a liaison and track all patients referred to care management programs
Work on projects assigned by the Operations Specialist and Senior Manager