79 Hoag Hospital jobs in Brea

Clinical Services Coordinator, Intermediate

90802 Long Beach, California Blue Shield of California

Posted today

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Job Description

Your Role

The Care Management Department is seeking a dedicated and compassionate Clinical Service Coordinator (CSC) to join our team. The Clinical Service Coordinator will report to the Supervisor of Care 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 will interact 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.

Your Work

In this role, you will:

  • Conduct telephonic outreach efforts to engage members and introduce them to care management services.
  • Complete thorough assessments to identify member needs and care gaps
  • Maintain accurate and up-to-date member records and documentation of all interactions and services provided
  • Conduct follow-up calls to ensure members’ needs are being met
  • Provide members with information and resources about available care management services and how to access them
  • Provides administrative/clerical support to medical and disease management programs.
  • Acts as a liaison, 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 to community resources, facilitation of medical services, referral to ancillary providers, etc.
  • Assists in verifying health plan benefits and coordinating ambulatory services.
  • Demonstrates cultural competence to work effectively, respectfully, and sensitively within the client’s cultural context.
  • Assists with precepting responsibilities for new hires and auditing efforts.

Your Knowledge and Experience

•   A minimum of a high school diploma
•   A minimum of 3 years of relevant experience
•   A minimum of 1 year experience in a managed care environment.
•   Health insurance/ managed care experience (Commercial, Medicare, and Medi-Cal)
•   Community resources and advocacy
•   Ability to identify issues and develop effective solutions to meet members' needs
•   Flexibility to adjust to changing circumstances and member needs
•   Strong verbal and written communication skills to effectively convey information to members and colleagues

View Now

Clinical Services Coordinator, Intermediate

95630 Lake Forest, California Blue Shield of California

Posted today

Job Viewed

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Job Description

Your Role

The  Behavioral Health Team is responsible the coordination of care and assistance in finding providers for members in need.  The Clinical Services Coordinator (CSC)- Intermediate (Appointment Assistance)  will report to the Supervisor, Operations -Behavioral Health. In this role you will be for supporting clinical staff day-to-day operations.

Your Work

In this role, you will:

  • Serve as a primary point of contact for members by providing support via inbound and outbound phone interactions
  • Conduct outreach to healthcare providers and programs to obtain information on services and appointment availability, coordinate appointments, and ensure continuity of care. 
  • Work in a production-based environment with defined production and quality metrics.
  • Oversee designated queues and workstreams, with standardized reports to detect and address member needs.
  • Assists in coordinating care for specific high risk/high-cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc.
  • Provide support to Case Management and/or Utilization Management team on member eligibility, benefits, and provider network availability.
  • Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.
  • Provides administrative/clerical support to Behavioral Health management.

Your Knowledge and Experience
 

  • Requires a high school diploma or equivalent
  • Requires at least 3 years of prior relevant experience
  • Desired certification and/or training as a patient advocate, health coach, care navigator or other relevant health plan experience
  • 2-year work experience with managed health care utilization or case management department or a similar medical management department at a different payor, facility, or provider/group.
  • Ability to work in a high-paced production environment with occasional overtime needed (including weekends) to ensure regulatory turnaround standards are met. 
  • Knowledge of clinical workflow to assist BH Care Managers with case creation, research/issue resolution and other UM related functions, as necessary.                             
View Now

Clinical Services Coordinator, Intermediate

95763 Lake Forest, California Blue Shield of California

Posted today

Job Viewed

Tap Again To Close

Job Description

Your Role

The  Behavioral Health Team is responsible the coordination of care and assistance in finding providers for members in need.  The Clinical Services Coordinator (CSC)- Intermediate (Appointment Assistance)  will report to the Supervisor, Operations -Behavioral Health. In this role you will be for supporting clinical staff day-to-day operations.

Your Work

In this role, you will:

  • Serve as a primary point of contact for members by providing support via inbound and outbound phone interactions
  • Conduct outreach to healthcare providers and programs to obtain information on services and appointment availability, coordinate appointments, and ensure continuity of care. 
  • Work in a production-based environment with defined production and quality metrics.
  • Oversee designated queues and workstreams, with standardized reports to detect and address member needs.
  • Assists in coordinating care for specific high risk/high-cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc.
  • Provide support to Case Management and/or Utilization Management team on member eligibility, benefits, and provider network availability.
  • Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.
  • Provides administrative/clerical support to Behavioral Health management.

Your Knowledge and Experience
 

  • Requires a high school diploma or equivalent
  • Requires at least 3 years of prior relevant experience
  • Desired certification and/or training as a patient advocate, health coach, care navigator or other relevant health plan experience
  • 2-year work experience with managed health care utilization or case management department or a similar medical management department at a different payor, facility, or provider/group.
  • Ability to work in a high-paced production environment with occasional overtime needed (including weekends) to ensure regulatory turnaround standards are met. 
  • Knowledge of clinical workflow to assist BH Care Managers with case creation, research/issue resolution and other UM related functions, as necessary.                             
View Now

Clinical Services Coordinator, Intermediate

90899 Long Beach, California Blue Shield of California

Posted today

Job Viewed

Tap Again To Close

Job Description

Your Role

The  Behavioral Health Team is responsible the coordination of care and assistance in finding providers for members in need.  The Clinical Services Coordinator (CSC)- Intermediate (Appointment Assistance)  will report to the Supervisor, Operations -Behavioral Health. In this role you will be for supporting clinical staff day-to-day operations.

Your Work

In this role, you will:

  • Serve as a primary point of contact for members by providing support via inbound and outbound phone interactions
  • Conduct outreach to healthcare providers and programs to obtain information on services and appointment availability, coordinate appointments, and ensure continuity of care. 
  • Work in a production-based environment with defined production and quality metrics.
  • Oversee designated queues and workstreams, with standardized reports to detect and address member needs.
  • Assists in coordinating care for specific high risk/high-cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc.
  • Provide support to Case Management and/or Utilization Management team on member eligibility, benefits, and provider network availability.
  • Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.
  • Provides administrative/clerical support to Behavioral Health management.

Your Knowledge and Experience
 

  • Requires a high school diploma or equivalent
  • Requires at least 3 years of prior relevant experience
  • Desired certification and/or training as a patient advocate, health coach, care navigator or other relevant health plan experience
  • 2-year work experience with managed health care utilization or case management department or a similar medical management department at a different payor, facility, or provider/group.
  • Ability to work in a high-paced production environment with occasional overtime needed (including weekends) to ensure regulatory turnaround standards are met. 
  • Knowledge of clinical workflow to assist BH Care Managers with case creation, research/issue resolution and other UM related functions, as necessary.                             
View Now

Clinical Services Coordinator, Intermediate

95763 Lake Forest, California Blue Shield of California

Posted today

Job Viewed

Tap Again To Close

Job Description

Your Role

The  Behavioral Health Team is responsible the coordination of care and assistance in finding providers for members in need.  The Clinical Services Coordinator (CSC)- Intermediate (Appointment Assistance)  will report to the Supervisor, Operations -Behavioral Health. In this role you will be for supporting clinical staff day-to-day operations.

Your Work

In this role, you will:

  • Serve as a primary point of contact for members by providing support via inbound and outbound phone interactions
  • Conduct outreach to healthcare providers and programs to obtain information on services and appointment availability, coordinate appointments, and ensure continuity of care. 
  • Work in a production-based environment with defined production and quality metrics.
  • Oversee designated queues and workstreams, with standardized reports to detect and address member needs.
  • Assists in coordinating care for specific high risk/high-cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc.
  • Provide support to Case Management and/or Utilization Management team on member eligibility, benefits, and provider network availability.
  • Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.
  • Provides administrative/clerical support to Behavioral Health management.

Your Knowledge and Experience
 

  • Requires a high school diploma or equivalent
  • Requires at least 3 years of prior relevant experience
  • Desired certification and/or training as a patient advocate, health coach, care navigator or other relevant health plan experience
  • 2-year work experience with managed health care utilization or case management department or a similar medical management department at a different payor, facility, or provider/group.
  • Ability to work in a high-paced production environment with occasional overtime needed (including weekends) to ensure regulatory turnaround standards are met. 
  • Knowledge of clinical workflow to assist BH Care Managers with case creation, research/issue resolution and other UM related functions, as necessary.                             
View Now

Clinical Services Coordinator, Intermediate

95630 Lake Forest, California Blue Shield of California

Posted today

Job Viewed

Tap Again To Close

Job Description

Your Role

The  Behavioral Health Team is responsible the coordination of care and assistance in finding providers for members in need.  The Clinical Services Coordinator (CSC)- Intermediate (Appointment Assistance)  will report to the Supervisor, Operations -Behavioral Health. In this role you will be for supporting clinical staff day-to-day operations.

Your Work

In this role, you will:

  • Serve as a primary point of contact for members by providing support via inbound and outbound phone interactions
  • Conduct outreach to healthcare providers and programs to obtain information on services and appointment availability, coordinate appointments, and ensure continuity of care. 
  • Work in a production-based environment with defined production and quality metrics.
  • Oversee designated queues and workstreams, with standardized reports to detect and address member needs.
  • Assists in coordinating care for specific high risk/high-cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc.
  • Provide support to Case Management and/or Utilization Management team on member eligibility, benefits, and provider network availability.
  • Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.
  • Provides administrative/clerical support to Behavioral Health management.

Your Knowledge and Experience
 

  • Requires a high school diploma or equivalent
  • Requires at least 3 years of prior relevant experience
  • Desired certification and/or training as a patient advocate, health coach, care navigator or other relevant health plan experience
  • 2-year work experience with managed health care utilization or case management department or a similar medical management department at a different payor, facility, or provider/group.
  • Ability to work in a high-paced production environment with occasional overtime needed (including weekends) to ensure regulatory turnaround standards are met. 
  • Knowledge of clinical workflow to assist BH Care Managers with case creation, research/issue resolution and other UM related functions, as necessary.                             
View Now

Clinical Services Coordinator, Intermediate

90802 Long Beach, California Blue Shield of California

Posted today

Job Viewed

Tap Again To Close

Job Description

Your Role

The Care Management Department is seeking a dedicated and compassionate Clinical Service Coordinator (CSC) to join our team. The Clinical Service Coordinator will report to the Supervisor of Care 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 will interact 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.

Your Work

In this role, you will:

  • Conduct telephonic outreach efforts to engage members and introduce them to care management services.
  • Complete thorough assessments to identify member needs and care gaps
  • Maintain accurate and up-to-date member records and documentation of all interactions and services provided
  • Conduct follow-up calls to ensure members’ needs are being met
  • Provide members with information and resources about available care management services and how to access them
  • Provides administrative/clerical support to medical and disease management programs.
  • Acts as a liaison, 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 to community resources, facilitation of medical services, referral to ancillary providers, etc.
  • Assists in verifying health plan benefits and coordinating ambulatory services.
  • Demonstrates cultural competence to work effectively, respectfully, and sensitively within the client’s cultural context.
  • Assists with precepting responsibilities for new hires and auditing efforts.

Your Knowledge and Experience

•   A minimum of a high school diploma
•   A minimum of 3 years of relevant experience
•   A minimum of 1 year experience in a managed care environment.
•   Health insurance/ managed care experience (Commercial, Medicare, and Medi-Cal)
•   Community resources and advocacy
•   Ability to identify issues and develop effective solutions to meet members' needs
•   Flexibility to adjust to changing circumstances and member needs
•   Strong verbal and written communication skills to effectively convey information to members and colleagues

View Now
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Clinical Services Coordinator, Intermediate

90899 Long Beach, California Blue Shield of California

Posted today

Job Viewed

Tap Again To Close

Job Description

Your Role

The  Behavioral Health Team is responsible the coordination of care and assistance in finding providers for members in need.  The Clinical Services Coordinator (CSC)- Intermediate (Appointment Assistance)  will report to the Supervisor, Operations -Behavioral Health. In this role you will be for supporting clinical staff day-to-day operations.

Your Work

In this role, you will:

  • Serve as a primary point of contact for members by providing support via inbound and outbound phone interactions
  • Conduct outreach to healthcare providers and programs to obtain information on services and appointment availability, coordinate appointments, and ensure continuity of care. 
  • Work in a production-based environment with defined production and quality metrics.
  • Oversee designated queues and workstreams, with standardized reports to detect and address member needs.
  • Assists in coordinating care for specific high risk/high-cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc.
  • Provide support to Case Management and/or Utilization Management team on member eligibility, benefits, and provider network availability.
  • Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation.
  • Provides administrative/clerical support to Behavioral Health management.

Your Knowledge and Experience
 

  • Requires a high school diploma or equivalent
  • Requires at least 3 years of prior relevant experience
  • Desired certification and/or training as a patient advocate, health coach, care navigator or other relevant health plan experience
  • 2-year work experience with managed health care utilization or case management department or a similar medical management department at a different payor, facility, or provider/group.
  • Ability to work in a high-paced production environment with occasional overtime needed (including weekends) to ensure regulatory turnaround standards are met. 
  • Knowledge of clinical workflow to assist BH Care Managers with case creation, research/issue resolution and other UM related functions, as necessary.                             
View Now

Clinical Services Manager - (Remote)

90001 Legal, California Maximus

Posted 17 days ago

Job Viewed

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Job Description

Permanent
Description & Requirements

Maximus is seeking a dedicated Clinical Services Manager to support the Colbert Consent Decree Illinois Outreach and Assessment team. In this role, you will act as a liaison to serve as a single point of contact for all transition entities. This would include communicating with Illinois state agencies, MCO's (managed care organizations), court appointed staff, and transitional prime agencies.

**This position requires up to 15% travel annually to Illinois.**

About the Program:

We have contracted with the State of Illinois Department of Healthcare and Family Services (HFS) to manage comprehensive assessment processes for various screening and assessment services, specifically the Williams and Colbert Consent Decrees Outreach and Transitional Assessment. Outreach includes in-person visits with Colbert Class Members in Cook County Nursing facilities and Williams Class Members in SMHRF facilities which provide education on their rights and evaluate their level of interest in potential transition to the community.

Transitional Assessments are conducted in-person with Colbert Class Members in Cook County Nursing facilities and Williams Class Members in SMHRF facilities interested in transitioning to the community. Evaluators assess individuals' functional needs in several areas to determine the level of support necessary for successful community transition.

Why Maximus?
- Work/Life Balance Support - Flexibility tailored to your needs!

- • Competitive Compensation -Bonuses based on performance included!

- • Comprehensive Insurance Coverage - Choose from various plans, including Medical, Dental, Vision, Prescription, and partially funded HSA. Additionally, enjoy Life insurance benefits and discounts on Auto, Home, Renter's, and Pet insurance.

- • Future Planning - Prepare for retirement with our 401K Retirement Savings plan and Company Matching.

- • Unlimited Time Off Package - Enjoy UTO, Holidays, and extended sick leave, along with Short and Long Term Disability coverage.

- • Holistic Wellness Support - Access resources for physical, emotional, and financial wellness through our Employee Assistance Program (EAP).

- • Recognition Platform - Acknowledge and appreciate outstanding employee contributions.

- • Tuition Reimbursement - Invest in your ongoing education and development.

- • Employee Perks and Discounts - Additional benefits and discounts exclusively for employees.

- • Maximus Wellness Program and Resources - Access a range of wellness programs and resources tailored to your needs.

- • Professional Development Opportunities-Participate in training programs, workshops, and conferences.

- •Licensures and Certifications-Maximus assumes the expenses associated with renewing licenses and certifications for its employees.

Essential Duties and Responsibilities:

- Serve as a senior level individual contributor or project manager on a wide variety of clinical consulting projects.

- Oversee the development and implementation of innovative methodologies to improve service levels and overall operational efficiency.

- Facilitate team design discussions to ensure appropriate solutions are implemented.

- Manage client expectations effectively.

Minimum Requirements

- BA/BS

- 3+ years of experience

- A Bachelor's degree and a minimum of three years of experience in mental health

Preferred Requirements

- An LCSW, LMSW, LMFT or LCPC

- Proficiency in Microsoft Office Suite

- Strong written and verbal communication skills

- Ability to meet with court monitors and work with community stakeholders and providers

Home Office Requirements

- Maximus provides company-issued computer equipment

- Reliable high-speed internet service

- Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity

- Minimum 5 Mpbs upload speeds

- Private and secure workspace

EEO Statement

Maximus is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, age, national origin, disability, veteran status, genetic information and other legally protected characteristics.

Pay Transparency

Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. Annual salary is just one component of Maximus's total compensation package. Other rewards may include short- and long-term incentives as well as program-specific awards. Additionally, Maximus provides a variety of benefits to employees, including health insurance coverage, life and disability insurance, a retirement savings plan, paid holidays and paid time off. Compensation ranges may differ based on contract value but will be commensurate with job duties and relevant work experience. An applicant's salary history will not be used in determining compensation. Maximus will comply with regulatory minimum wage rates and exempt salary thresholds in all instances.

Minimum Salary

$

90,000.00

Maximum Salary

$

114,000.00

Apply Now

Clinical Services Coordinator, Intermediate (BH Intake)

90899 Long Beach, California Blue Shield of California

Posted today

Job Viewed

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Job Description

Your Role

The Behavioral Health Services (BHS) Clinical Intake team is responsible for timely and accurate processing of Treatment Authorization Requests. The Behavioral Health (BH) Clinical Services Coordinator (CSC), Intermediate will report to the BH Manager of Clinical Intake. In this role you will be completing intake activities, based upon provider/facility requests, for Commercial and Medicare lines of business.

Your Work

In this role, you will:

  • Work in a production-based environment with defined production and quality metrics
  • Process phoned in Prior Authorization or Hospital Admission Notification Requests, Utilization Management (UM) requests and/or calls left on voicemail
  • Data entry including authorization forms, high risk member information, verbal HIPPA authorizations information for case creation
  • Assign initial Extension of Authority (EOA) days, or triage to clinicians, based on established workflow
  • Research member eligibility/benefits and provider networks
  • Assist with system letters, requests for information and data entry
  • Provide administrative/clerical support to Behavioral Health Utilization Management Clinicians
  • 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 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
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