The position is responsible for overseeing the development, implementation, and daily operations of the Care Management teams including Transitional Care Management and Behavioral Health Treatment (BHT) services. The incumbent will ensure the delivery of quality and consistent concurrent review, recommendations, and referrals in accordance with CalOptima policies and procedures for OneCare/OneCare Connect (OC/OCC) beneficiaries. The incumbent will collaborate with other internal CalOptima departments to ensure all regulatory requirements are met. The incumbent will assist the Director of Behavioral Health Services (Clinical Operation) in developing and implementing behavioral health initiatives and projects. The incumbent will represent CalOptima and interact with the County of Orange, contracted organizations and providers, health networks, and other stakeholders in a manner that promotes collaborative working relationships.
POSITION RESPONSIBILITIES:
- Hires, manages, trains, reviews, and sets goals for department and staff.
- Facilitates weekly care management and concurrent review meetings to review and plan interventions for inpatient, partial hospitalization, and intensive outpatient services.
- Provides oversight and guidance for OC/OCC concurrent review and transitional care services while assisting with additional support as needed for cases with complex behavioral health needs.
- Provides oversight and guidance to BHT team assisting Medi-Cal (MC) beneficiaries.
- Participates in the development, implementation and improvement of departmental policies and procedures.
- Develops and prepares reports to meet internal, regulatory, contractual and accreditation requirements.
- Stays up to date with federal, state and local regulations that pertain to behavioral health services for all lines of business.
- Builds, maintains, and enhances relationships with the County of Orange, providers, health networks, community-based organizations, and other key stakeholders.
- Acts as a liaison to community based and governmental providers that serve members.
- Other projects and duties as assigned.
Required Skills
- Work in a team environment, be flexible, and adapt to change.
- Manage multiple deadlines in a fast-paced environment.
- Work collaboratively with a wide variety of stakeholders.
- Communicate effectively, both verbally and in writing, with individuals from diverse backgrounds.
- Effectively engage and lead a team of staff toward a common set of goals.
- Work with all levels of staff to identify issues and problem solve.
- Have exceptional initiative and follow-through on projects with minimal supervision or guidance.
- Help develop, implement and, enhance effective processes to integrate behavioral health into CalOptima’s care delivery system.
- Develop and champion innovative solutions to optimize programs for vulnerable populations.
- Create and seize opportunities for innovative new program development for integrating behavioral health services.
- Create and maintain effective working relationships both internally and with community based organizations, other governmental agencies, and with the population being served.
- Utilize and access computer and appropriate software (e.g. Microsoft Office: Word, Excel, PowerPoint) and job specific applications/systems.
Required Experience
EXPERIENCE & EDUCATION:
- Master's degree in Social Work, Clinical Psychology, Marriage and Family Therapy or other related degree is required.
- Licensed LCSW or LMFT required. Licensed Psychologist strongly preferred. Must hold current, unrestricted license to practice in California.
- 4 years of supervisor or manager level experience required. Experience in a managed care environment with specific experience in inpatient concurrent review or case management preferred.
- 1 year experience in behavioral health audits (including CMS, DHCS, DMHC, and NCQA) preferred.
- 1 year experience in developing policies and procedures to meet federal and state regulatory requirements preferred.
- 1 year experience in developing sound and responsible business plans and financial models preferred.
KNOWLEDGE OF:
- Managed care, Medicare, and Medi-Cal, with strong experience in applying the appropriate regulations and guidelines to behavioral health care services.
- Cultural needs for serving a socially and ethnically diverse population.
- The specific and unique needs of individuals with mental illness and substance use disorders, and of the available resources in the Orange County community to meet these needs.
- The continuum of mental health and substance use disorder services that can be provided to meet the needs of a diverse population.
Grade: O
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