Your Role

The Behavioral Health Utilization Management team provides utilization management and support for member seeking behavioral health treatment. The Clinical Services Coordinator will report to the Manager of Behavioral Health Utilization Management. In this role you will assist the member, family and/or caregiver, and provider in the treatment and management of Behavioral Health services, in consultation with the Board Certified Behavior Analyst (BCBA).

Your Work

In this role, you will:

• Process faxed/phoned in authorization requests, UM/CM requests and/or calls left on voicemail.
• Select support for Case Manager such as mailings, surveys
• Data entry including authorization forms, high risk member information, verbal HIPPA authorizations, information for case creation, in consultation with the Board Certified Behavior Analyst (BCBA).
• Support to Advanced/Specialist CSC
• Assign initial EOA days, or triage to clinicians, based on established workflow
• Research member eligibility/benefits and provider networks
• Be responsible for establishing trusting relationships with members while providing person-centered support and services
• Provide members and/or family members with care coordination, generate referrals to contracted ancillary service providers and community agencies in collaboration with the member's provider
• Document assessments, referrals, and case notes in the electronic case management and tracking systems within the established department guidelines
• Provide telephonic triage and care management assistance to members seeking access to the Behavioral Health Therapy (BHT) benefit
• Follow up efficiently with PCP offices to obtain necessary documents

Your Knowledge and Experience

• Requires at least 3 years of prior relevant experience
• Requires a High School diploma or equivalent
• Bilingual in Spanish preferred
• Ability to enter data into the computer and extract information from databases required
• Excellent communication skills with individuals internal and external to BSC including physicians, members, patients, and service providers required
• Ability to assist the member, family and/or caregiver, and provider in the treatment and management of BHT services, in consultation with the Board Certified Behavior Analyst (BCBA) required

Pay Range:

The pay range for this role is: $ 20.47 to $ 28.66 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.