YourRole TheCareManagement Department is seeking adedicated and compassionate Clinical Service Coordinator (CSC) to join our team.The Clinical Service Coordinatorwill report to the SupervisorofCare Operations.The CSC will play a vital role in outreach and engagement efforts with our members, introducing them to care management services, and conducting assessments to identify their needs. The successful candidate willinteract telephonically with members to assist with simple care coordination needs and facilitate connections between members and appropriate services, including internal nurse care managers, vendors, and behavioral health providers.YourWork Inthisrole,youwill:Conduct telephonic outreach efforts to engage members andintroduce them to care management services.CompletethoroughassessmentstoidentifymemberneedsandcaregapsMaintain accurateand up-to-datememberrecordsanddocumentation ofall interactions and services providedConductfollow-upcallstoensuremembers’needsarebeingmetProvide members with information and resources about available care management services and how to access themProvidesadministrative/clericalsupporttomedicalanddiseasemanagementprograms.Acts as aliaison, gathers information, and track all patients referred to the care management programs.Assists in coordinating care for specific high risk/high-cost patient population, including referrals tocommunity resources, facilitation ofmedical services, referral to ancillary providers,etc.Assistsinverifyinghealthplanbenefitsandcoordinatingambulatoryservices.Demonstratesculturalcompetencetoworkeffectively,respectfully,andsensitivelywithin the client’s cultural context.Assistswithpreceptingresponsibilitiesfornewhiresandauditingefforts. YourKnowledgeandExperience AminimumofahighschooldiplomaAminimumof3yearsofrelevantexperienceAminimumof1yearexperienceinamanagedcareenvironment.Bi-Lingual: Must be fluent in English and SpanishHealthinsurance/managedcareexperience(Commercial,Medicare,andMedi-Cal)CommunityresourcesandadvocacyAbilitytoidentifyissuesanddevelopeffectivesolutionstomeetmembers'needsFlexibilitytoadjusttochangingcircumstancesandmemberneedsStrong verbal and written communication skills to effectively convey information to members and colleagues

Your Role The Network Contracting and Trend Analytics (NTA) team supports the Network Management team with analytical and financial modeling for provider contracting and network development activities for Blue Shield of California. The Senior Principal, Medical Informatics of NTA will report to the Senior Director of NTA. In this role you will be responsible for behavioral health finance analytics including measurement of internal cost of healthcare and reporting, analytics supporting coordination of care opportunities, and oversight of provider contracting analytics. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.Your Work In this role, you will: Develop the financial management and modeling best practices, specifically for Behavior Health as we move to an in-sourced environmentImplement on-going behavior health costs analysis and trendsBe responsible for CoHC - Behavior HealthBe the lead on modeling the financial aspects. Example, evaluating the financial aspects of care activities such as hospital ER vs behavioral health servicesLead all financial aspects in developing Value-Based Contracting, specifically in Behavior Health marketplace.Be accountable for development of the financial contractual arrangements and the implementation of these providers, which we are bringing in house Your Knowledge and Experience Requires a college degree or equivalent experienceMPH, MBA, MS, MA, RN, or RHIA preferredRequires 10 years of relative experienceRequires a minimum of 5 years’ experience in Health Care (managed care, academic, or gov't payer)Requires contracting in healthcare with a behavioral health specialtyRequires experience developing programs that will translate into CoHC savings specifically in extensive vendor knowledge of financial healthcare within behavioral healthRequires experience with behavioral health financial reporting and modelingRequires one to be comfortable with an ever changing business model that is continually seeking the optimal solution in the behavioral health spaceRequires a SAS Certified Base Programmer Credential or equivalent or a SAS Certified Advanced Programmer Credential or equivalent