Clinical Services Coordinator, Intermediate (BH Specialty Team)

Your Role

The Behavioral Health Services (BHS) Specialty team manages continuity of care (CoC) requests, exception requests, and provides support for the clinical Behavioral Health Utilization Management team. The Behavioral Health (BH) Clinical Services Coordinator (CSC), Intermediate will report to the BH Manager of the Specialty team. In this role you will be triaging and opening CoC and exception requests, conduct research to determine eligibility, conduct outreach to providers to obtain additional/clarifying information, and provide administrative support to the Behavioral Health Utilization Management clinical team.

Your Work

In this role, you will:

• Work in a production-based environment with defined production and quality metrics
• Process faxed/portal submissions for continuity of care (CoC) and exception requests
• Conduct research in various systems to determine eligibility of the requests
• Provide administrative/clerical support to Behavioral Health Utilization Management Clinicians
• Build cases, complete data entry, authorize services based upon predefined guidelines, and issue determination letters
• Coordinate/schedule peer to peer conversations between requesting providers and Blue Shield Behavioral Health Medical Directors
• Other duties as assigned

Your Knowledge and Experience

• Requires a high school diploma or equivalent
• Requires at least 3 years of prior relevant experience
• 1 year work experience in a call center environment preferred
• Working knowledge of the systems/tools utilized for UM authorization functions such as FACETS, MedHok, preferred
• Knowledge of Federal and CA state Continuity of Care requirements
• Knowledge of Behavioral Health treatment levels of care preferred
• Knowledge of health plan terminology preferred
• Ability to work in a high-paced production environment with occasional overtime needed (including weekends) required