Sr. Manager of Behavioral Health Access

To direct and coordinate medically necessary behavioral health treatment services for members seeking behavioral health services. Oversees operations of Behavioral Health Call Center and staffing. Oversees staff to ensure the coordination of care for members seeking behavioral health services for both carved in and carved out services. Ensures regulatory compliance with call center performance requirements.

Responsibilities

Manages the day-to-day operations of the behavioral health call center. Builds strong, competent staff to enhance the member experience, which may include supporting access to care and ensuring closed loop referrals. Accountable for developing performance standards and implementing monitoring mechanisms to ensure service level expectations are met. Responsible for program evaluation and oversees training, creation of policies and procedures, and facilitation of meetings and projects. Plans, implements and provides ongoing direction for quality assurance and quality improvement activities of the Behavioral Health member experience team. Works with department leadership and internal stakeholders to ensure Behavioral Health Department is meeting intended goals in support of the member experience. Monitors and evaluates the efficiency and effectiveness of service delivery methodsand procedures. Represents the Behavioral Health Department at meetings and maintains relationships with internal and external stakeholders, community partners, and regulatory agencies. Ensures regulatory compliance and performance standards for the Call Center. Provides day-to-day oversight and support of the Behavioral Health Access staff. Establishes operational workflows, best practices and continuous improvement activities. Participates in the development of departmental policies and procedures. Assists with development of system changes or upgrades as needed. Facilitates and/or attends appropriate committees, meetings, and trainings. Participates in the development and revision of member materials. Provides backup on phones as needed including the screening of members using proscribed screening tools and directs members to appropriate providers. Assists with compliance of DHCS, DMHC, CMS, and NCQA requirements andstandards. Oversees review and processing of daily, weekly and monthly access line reporting to ensure timely access, closed loop referrals, and call performance measures are met.

Oversees operations of staff managing specialized case load of members with behavioral health needs which interfere with positive healthcare outcomes. Collaborates and consults with care providers, member, and/or the multidisciplinary care team to assist in understanding the members behavioral health needs. Acts as a support/resource to others within the organization for behavioral health cases. Knowledge of and ability to coordinate with multiple systems of care including county based behavioral health services. Functions collaboratively in a team environment. Utilizes best practices in coordination of behavioral health services in accordance with established guidelines associated with access line workflows. Coordinates with medical providers, psychiatrists, drug and alcohol counselors, case managers, and other support staff to ensure continuum of care. Oversees the performance of screenings to assist in coordinating behavioral health services. Maintains accurate and timely documentation, records, and case files in the Partnership HealthPlan of California (Partnership) Case Management System for members in behavioral health access line management system. Develops and maintains knowledge of a community-based network of alternative modes of care. Aids member to connect with community-based organizations to support and enhance wellness. Conducts and contributes to special training for Partnership staff, professionals, public and private agencies and others as identified. Assists with training and relevant educational materials for Behavioral Health Access Guides. Handles complex and lengthy calls that cannot be resolved by the Behavioral Health Access Guides or Leads. Attends and delivers community presentations and orientations as needed. Educates members and providers on the guidelines and policies of Partnership . Assesses and resolves problems within scope of authority; escalates unusual questions or problems to higher authority levels. Communicates clearly and effectively through all mediums of communication with members, providers, vendors, community partners, and Partnership employees. Supports successful transition of care for members discharged from a residential setting transitioning to a lower level of care within the community, to include assessing member needs and identifying appropriate staff to carry out identified needs, effective and frequent communication with providers, members, county partners and identified health care designee. Performs other duties as assigned including the assumption of new dutie

Qualifications

Education and Experience

Master’s degree in a behavioral health related area preferred; at least five(5) years of relevant program management experience required. In lieu of a degree, a minimum of eight (8) years of relevant experience to include a minimum of five (5) years management experience will beconsidered. Experience managing program teams with multiple position levels. Experience in publicly funded behavioral health and in a health plan environment preferred.

Special Skills, Licenses and Certifications

Ability to actively listen, engage members who may be having active behavioral health challenges by using motivational interviewing techniques. Considerable knowledge of prevention, treatment and rehabilitation techniques used in the identification and treatment of mental illness and emotional disorders. Federal, state and local laws, rules and regulations associated with mental health treatment and education programs. Understanding of the treatment of mental illness and substance use disorders Valid California driver’s license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business.

Performance Based Competencies

Strong organizational, communication, attention to detail and critically thinking skills required. Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple priorities and meeting deadlines. Ability to work across systems of care and engage members and providers to coordinate care and services. Effective telephone and computer data entry skills required. Experience in managed care business practices and ability to access data information using computer systems. Excellent English written and verbal communication skills.

Work Environment And Physical Demands

Daily use of the telephone and computer for most of the day. Standard cubicle workstation. Must be able to lift, move, or carry objects of varying size, weighing up to 10lbs.

All HealthPlan employees are expected to:

Provide the highest possible level of service to clients;

Promote teamwork and cooperative effort among employees;

Maintain safe practices; and

Abide by the HealthPlan’s policies and procedures, as they may from time to time be updated.

HIRING RANGE

$136,296.78 - $177,185.82

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

Regular Full-Time