JOB DESCRIPTION
Your Work

In this role, you will:

• Be responsible for establishing trusting relationships with members while providing person-centered support and services
• Conduct telephonic social determinants of health needs assessment with moderate acuity members to address social barriers and care gaps
• Provide members and/or family members with care coordination, referrals and linkage to Health Plan resources and community agencies
• Document assessments, referrals and case notes in the electronic case management and tracking systems within the established department guidelines
• File and make necessary follow-up on mandated reporting, e.g. Adult Protective Services, Child Protective Services, etc.
• Provide telephonic support to member and/ or family members following their discharges from hospitals and other medical facilities.
• Coordinates services with State and community programs on behalf of the member, particularly when the member is unable to effectively do so independently.
• Prepares logs and reports as needed for meetings and audits
• Any other assigned duties

QUALIFICATIONS
Your Knowledge and Experience

• Requires a High School diploma or equivalent
• Bachelor’s degree preferred
• Requires at least 5 or more years of prior relevant experience
• Requires at least 3 years of prior relevant experience with a Medi-Cal Managed Health Plan.
• Medi-Cal (Medicaid)/Medicare Experience
• Required experience with managing electronic health records and documenting in clinical case management systems.
• Required excellent communication skills both orally and in writing with all levels of BSC Promise staff, members, contracted physicians, participating provider groups, and community-based organizations.
• Required effective time management skills and ability to define and act on priorities efficiently
• Desired knowledge of governmental and private organizations, resources in the community, laws, regulations, and policies
• Experience working with or for a managed health care plan
  

Pay Range:

The pay range for this role is: $ 19.83 to $ 27.76 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.

ABOUT THE TEAM
Blue Shield of California’s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area’s top companies in volunteering & giving, and one of the world’s most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in – join us!

Our Values:

• Honest . We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human . We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
• Courageous . We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

From the earliest days of the pandemic, Blue Shield of California has been unyielding in our commitment to putting the health and safety of our people, our members and our communities first. As a health care company, Blue Shield requires all employees to be up to date with COVID-19 vaccination prior to start date as a condition of employment. Blue Shield will consider requests for medical or religious accommodation to this vaccination requirement prior to your start date.

The definition of "up to date with your COVID-19 vaccine" is when you have received all doses in the primary series and one booster when eligible. If you are unable to be up to date with your COVID-19 vaccine by your start date, your start date will need to be postponed and you will have 30 days to remedy. If you cannot fulfill the requirement nor obtain an accommodation within 30 days, your offer will be rescinded.