Clinical Services Coordinator, Intermediate

Company: Blue Shield of California
Location: Oakland
Posted on: March 6, 2025

Job Description:

Your Role The Pharmacy Non-Clinical Support Queue team provides efficient and accurate responses to external customers (physicians, office staff, pharmacy providers, members, and brokers) and internal team members for all outpatient pharmacy benefit inquiries. The Clinical Services Coordinator, Intermediate, will report to the Operations Supervisor. In this role you will complete outbound written and oral notifications to both members and providers, run daily internal reports and process our incoming cases for verification. Your Work In this role, you will:

• Make sure all member and provider notifications are sent to Members/MD offices in a timely manner after Prior Authorization cases have been decided.
• Ensure all notifications are completed within turn-around times to meet compliance.
• Run, sort and filter daily internal reports for manual outreach.
• Make outbound calls to BSC members and providers related to decision Prior Authorization request.
• Receive and process prior authorization request Your Knowledge and Experience
  • Requires at least 3 years of related experience and training; or equivalent combination of education and experience
  • Pharmacy experience preferred
  • Demonstrated ability encompasses basic understanding of internal procedures and policies needed to ensure effective execution of assigned tasks
  • Ability to multi-task, set priorities, and manage time effectively
  • Strong phone and verbal communication skills along with active listening
  • Previous experience with Microsoft Office Programs, ie - Outlook, Excel, Word

Keywords: Blue Shield of California, Oakland , Clinical Services Coordinator, Intermediate, Healthcare , Oakland, California