Blue Shield of California · 19 hours ago
Clinical Services Coordinator, Intermediate
Rancho Cordova, CA, United States
Full-time
Hybrid
Mid Level
$21.73/hr - $30.43/hr
3+ years expBlue Shield of California is a nonprofit organization focused on creating a sustainable healthcare system. The Clinical Services Coordinator will support clinical staff with the processing of Treatment Authorization Requests and assist in various administrative tasks within the Clinical Services Intake team.
Financial ServicesHealth InsuranceNon Profit
No H1B
Responsibilities
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
Qualification
Required
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
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
Preferred
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
Company
Blue Shield of California
Blue Shield of California is a health insurance service provider.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Gary Culp
Senior Vice President, Government Markets
Gregory Siebert
Senior Vice President Provider Partnerships & Network Management
Recent News
2026-01-13
Fierce Healthcare
2025-12-15
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