FAQs
What are the primary responsibilities of the Clinical Services Coordinator, Intermediate in the Children’s Health Program team?
The Clinical Services Coordinator, Intermediate is responsible for processing faxed/phoned in authorizations, conducting data entry, researching member eligibility/benefits and provider networks, providing operational support for healthcare services, serving as the initial point of contact for members and providers, reviewing specific CHP eligibility referrals, processing service authorization referrals, and providing administrative/clerical support to medical management.
What level of experience is required for the Clinical Services Coordinator, Intermediate position?
The position typically requires a minimum of 3 years of experience. A vocational or technical education in addition to prior work experience may be required. Additionally, at least 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 is preferred.
What knowledge and skills are necessary for success in this role?
The ideal candidate should have a basic understanding of systems and procedures related to medical management obtained through prior work experience or education. Familiarity with UM regulatory TAT standards, prior authorization and/or concurrent review non-clinical business rules and guidelines, and proficiency in processing medical records and requests in alignment with nationally recognized standards are also important.
What is the reporting structure for the Clinical Services Coordinator, Intermediate role?
The Clinical Services Coordinator, Intermediate will report to the Children’s Health Program (CHP) Manager within the Promise Clinical Team. They will work closely with clinical staff to support member needs using established and approved Blue Shield Medical Policies and Guidelines.