Intermediate Clinical Services Coordinator
- Blue Shield of California
- | Shingle Springs, CA
$17.33 per hour |
OTHER |
July 24th, 2025
-
Blue Shield of California -
Shingle Springs, CA
-
$17.33 per hour
-
OTHER
-
July 24th, 2025
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:
- 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 and surveys.
- Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.
- Provide 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 the 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 representatives. Other duties as assigned.
Your Knowledge and Experience
- 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 of work experience within the Medical Care Solutions' Utilization Management Department or a similar medical management department at a different payor, facility, or provider/group preferred.
- 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 preferred.
- 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 preferred.
- 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.
Subscribe for Latest Jobs
Get job updates directly to your inbox.
Share This job
Spread the word through your favorite platforms.
Similar Jobs
Your RoleThe Care Management Department is seeking a dedicated and compassionate Clinical Service Coordinator (CSC) to join our team. The Clinical Service Coordinator will report to the Supervisor of Care Operations. The CSC will play a vital role in outreach and engagement efforts with our members, introducing them to care management services, and conducting ass...
At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make lives better. Our mission is to help people lead healthier, more fulfilling lives by improving access to trusted, affordable, and personalized mental healthcare. Everywhere. Every day. It's a lofty goal; we know. But we make it happen with the best...
Setting: OutpatientMake a meaningful impact as a Licensed Clinical Social Worker with Jackson Therapy Partners! We're seeking an experienced LCSW who'll advocate for patients or students to help them gain access to available resources while confronting personal challenges like mental illness, addiction, and abuse. Combine your passion for helping others with your...
Make a Difference on Your Own Schedule and Terms!Summary The Certified Mobile Research Nurse is a Registered Nursing per diem/PRN position for PCM Trials. A PCM Trials CMRN is responsible for setting appointments within the required visitation window to complete mobile visits for study participants. You'll work cooperatively with Clinical Project Managers, Coordi...
Remote Licensed Clinical Social Worker (LCSW) Wage: Between $86-$130 an hour Are you a Licensed Clinical Social Worker looking to launch a private practice, or grow your existing practice? Headway can help you earn more through insurance! Headway supports thousands of mental health clinicians across the United States in our mission to rewire the mental healt...
At Gentle Dental, we value our teammate's smile as much as our patient's smile. Our vision is to provide exceptional, lifelong, integrated oral healthcare services. We enhance the quality of our patients' lives by providing accessible oral healthcare, which is paramount to overall health and wellbeing. We focus on a commitment to patient care, operational and cl...
Supplemental Health Care is seeking a Social Work Licensed Clinical Social Worker for a travel job in Oakland, California.Job Description RequirementsSpecialty: Licensed Clinical Social WorkerDiscipline: Social WorkStart Date: ASAPDuration: 13 weeks40 hours per weekShift: 8 hours, daysEmployment Type: TravelJob Description:Supplemental Health Care is seeking Lic...
Host Healthcare is seeking a travel nurse RN Labor and Delivery for a travel nursing job in Visalia, California.Job Description RequirementsSpecialty: Labor and DeliveryDiscipline: RNStart Date: 07/24/2025Duration: 13 weeks36 hours per weekShift: 12 hours, nightsEmployment Type: TravelHost Healthcare is an award-winning travel healthcare company with an immediat...
Department/Unit:Medical/Surgical Hospitalist - E4Work Shift:Night (United States of America)Salary Range:$72,072.00 - $74,229.26Clinical NurseJob Description SummaryThe clinical Nurse contributes to the creation of a compassionate and caring environment for patients, families and colleagues through displays of kindness and active listening. Recognizes and appreci...
High-Volume Searches
- Services Coordinator jobs
- Services Coordinator jobs near Shingle Springs, CA
- Services Coordinator jobs Shingle Springs, CA
- Services Coordinator jobs hiring near Shingle Springs, CA
- Services Coordinator jobs in Shingle Springs, CA
- Services Coordinator jobs near me
Blue Shield of California Searches
- Blue Shield of California jobs
- Blue Shield of California jobs near Shingle Springs, CA
- Blue Shield of California jobs hiring near Shingle Springs, CA
- Blue Shield of California jobs in Shingle Springs
- Blue Shield of California jobs near me
- Blue Shield of California careers
- Blue Shield of California vacancies
Geographic Searches
- Blue Shield of California Services Coordinator jobs near Shingle Springs, CA
- Intermediate Clinical Services Coordinator jobs near Shingle Springs, CA
- Intermediate Clinical Services Coordinator jobs hiring near me Shingle Springs, CA
- Intermediate Clinical Services Coordinator jobs in Shingle Springs
- Intermediate Clinical Services Coordinator jobs near me
Searches you may like:
- Nearby Hospital Jobs
- Nearby Healthcare Jobs
- Medical Jobs
- Jobs Near Me
- Full Time Rn Jobs Near Me
Explore opportunities in nearby cities:
- Treatment Coordinator, Ortho Jobs Near Antelope, CA
- Pediatric Clinical Research RN Jobs Near Auburn, CA
- Licensed Clinical Social Worker Jobs Near Carmichael, CA
- General Med/Surg Clinical Nurse II Jobs Near Citrus Heights, CA
- Travel Licensed Clinical Social Worker Jobs Near El Dorado Hills, CA