DEPARTMENT(S): Behavioral Health Integration
REPORTS TO: Supervisor, Behavioral Health (ABA)
FLSA STATUS: Non-Exempt
SALARY GRADE: C - $41,000 - $53,000
The position is responsible for providing care management support to members seeking Behavioral Health Treatment (BHT), including Applied Behavior Analysis (ABA). The incumbent will assist members in linking BHT services, following up with members before and after appointment, providing members with information and referrals to community resources, conducting utilization review, and navigating the behavioral health system of care. This position will act as a consultative liaison to assist members, health networks and community agencies to coordinate BHT and related behavioral health services. The incumbent directly interacts with providers, facilities, and members.
POSITION RESPONSIBILITIES:
- Assists members in securing BHT and related behavioral health services.
- Provides ongoing care management support for members receiving ABA services.
- Coordinates member’s behavioral and social service needs both within and outside CalOptima to ensure the coordination of members’ care.
- Collaborates and communicates with the member, family, conservators, significant other(s), physicians, health networks and other health care providers to facilitate coordination of care.
- Develops and maintains a network of current community resources and services where members can be referred to for assistance.
- Maintains documentation of member cases within the Medical Management System and Facets, as needed.
- Initiates referrals to both internal and external care management departments, and other government agencies.
- Other projects and duties as assigned.
KNOWLEDGE & ABILITIES:
- Develop rapport, establish, and maintain effective interpersonal relationships with internal and external contacts at all levels.
- Adhere to CalOptima policies/procedures (i.e., PHI/HIPAA).
- Develop creative/innovative approaches to challenges and opportunities.
- Prepare comprehensive written reports and maintain accurate records. Prepare and provide effective orientations and educational presentations.
- Work with appropriate departments to expedite the resolution of member concerns.
- Communicate clearly and concisely, both verbally and in writing to a diverse population.
- Utilize and access computer and appropriate software (e.g., Microsoft: Word, Excel, PowerPoint) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position.
EXPERIENCE & EDUCATION:
- High school degree or equivalent is required.
- 2+ years of experience in Behavioral Health, Community Services, or other Social Services setting required.
- Have access means of transportation for work away from the primary office approximately 5% of the time.
PREFERRED QUALIFICATIONS:
- Bachelor's degree in Behavioral Health or related field is preferred.
- Experience working with children diagnosed with Autism Spectrum Disorder (ASD) preferred.
- HMO, Medi-Cal/Medicaid, and Health Services experience preferred.
- Bilingual in English and in one of CalOptima's defined threshold language (Spanish, Vietnamese, Arabic, Farsi, Korean, or Chinese) is preferred.
KNOWLEDGE OF:
- Available health plans and CalOptima’s benefit structure.
- Issues that face members diagnosed with ASD.
- Treatments for ASD including ABA services.
- Principles and practices of health care service delivery and managed care.
- Principles and techniques for effective communication and education.
- Appropriate techniques to serve the population in diverse backgrounds.
- Appropriate methods and techniques to track and respond to service-related complaints and grievances.
EEO Statement: CalOptima is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima wants to have qualified employees in every job position. CalOptima prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.
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ADA/Accommodation Statement: If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations with 72-hour notice by contacting Human Resources Disability Management at 657-900-1134.
Required Skills
Required Experience