Program Coordinator, Experienced

Job Description

Your Role

The Social Programs team is responsible for the support, oversight and administration of Social Programs benefits and services ensuring that our eligible members receive appropriate services in-line with benefits and services that is member-centered and in the communities where our members seek care. The Program Coordinator, Experienced will report to the Senior Manager, Social Programs Management. In this role you will play a key role in supporting administrative and operational organizations while regularly providing support and assistance to our Providers (Community Health Worker, Enhanced Care Management, Community Supports, Community Based Adult Service Providers, and Correctional Facilities) to facilitate their ability to provide the full scope of the Medi-Cal benefit and/or services to our members.

Responsibilities

Your Work

In this role, you will:

• Serve as the Plan’s designated Justice-Involved (JI) Liaison, supporting the effective operationalization of the statewide JI Mandate to improve coordination of care for individuals being released from jails and prisons who qualify for Enhanced Care Management services under the JI Population of Focus
• Be responsible for strategic alignment and integration across projects/programs, from initiation through delivery, in support of business unit process and administrative efficiency
• Define projects required to support programs and partners to ensure their implementation on time, within budget and with benefits realized
• Participate cross-functionally in business planning to support business unit strategy
• Be responsible for large/complex projects/programs
• Exercise independent judgement in developing methods, techniques and evaluation criterion for obtaining results
• Support business objectives, unit processes, and administrative efficiency under the guidance of Senior and Program Managers and/or leaders, ensuring that all state and federal rules and regulations are followed
• Review referrals to determine member eligibility for the for Social Programs benefits and services, processing daily service authorizations and denials for requested benefits and services
• Perform data entry, tracking and case documentation for all members referred to services, including enrollment status, authorizations, encounter data, activities, clinical case records and regulatory reports
• Facilitate timely Provider submission of deliverables and reports and conduct review of said deliverables and reports to ensure accurate data collection and reporting
• Perform other assigned duties, as required
  
  

Qualifications

Your Knowledge and Experience

• Requires a bachelor’s degree or equivalent experience
• Requires at least 3 years of prior relevant experience
• Requires a broad knowledge of operational systems and practices typically gained through extensive experience and/or education.
• Desire experiences partnering with provider groups, community resources and agencies, and correctional facilities
• Desire minimum 2 years of experience with managed care plan
• Requires strong administrative skills including proficiency in Excel, Microsoft Word and Microsoft Outlook and the ability to multitask and track multiple projects/deliverables at one time
• Requires experience communicating effectively to leadership and peers
  
  

About The Team

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield isa U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – 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 listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.
  
  

Our Workplace Model:

At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose – whether working in the office or through a hybrid approach – by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working:

• Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:
• Member-facing and approved out-of-state roles remain remote.
• Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
• On-Site: Work from a business unit-approved office an average of four (4) or more days a week.
  
  

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.