WHY CALOPTIMA? CalOptima is the single largest health plan in Orange County, serving 880,000 members, or one in four residents. Our motto — "Better. Together.” — is at the heart of our mission to serve members with excellence, dignity and respect. We are a public agency made up of compassionate leaders and professionals working together to strengthen our community’s health. If you’re looking for an opportunity to work for an organization dedicated to improving local health care and serving the needs of the most vulnerable, we encourage you to join CalOptima.

JOB SUMMARY

The Member Liaison Specialist (Behavioral Health) is responsible for assisting Medi-Cal, OneCare and OneCare Connect members with behavioral health care management needs in a call center environment, which includes but is not limited to, securing behavioral health appointments for members, following up with members before and after the initial appointment, providing members with information and referring to community resources and assisting member in navigating the behavioral health system of care. The Member Liaison Specialist will act as a consultative liaison to assist members, behavioral health providers, health networks and community agencies to coordinate behavioral health services. The incumbent will also participate in various behavioral health initiatives and projects in support of the Behavioral Health Integration Department.

POSITION RESPONSIBILITIES:

• Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.
• Provides members with short-term care management support and securing behavioral health services appointments.
• Coordinates member’s behavioral health needs both within and outside of CalOptima Health to ensure the coordination of member’s care.
• Collaborates and communicates with the member and/or caregiver and behavioral health network providers to support successful linkage to behavioral health services.
• 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.
• Initiates referrals to both internal and external care management departments and other government agencies.
• Outreaches to members and/or providers regarding new and/or ongoing behavioral health initiatives such as Interdisciplinary Care Team (ICT) and Health Homes Program (HHP) participation.
• Manages behavioral health projects such as the Provider Search Tool to identify network provider availability and specialties, County Step Downs to coordinate care for members transitioning from Orange County Behavioral Health to CalOptima Health’s Behavioral Health providers and Letter of Agreement requests to assist members with continuity of care.
• Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
• Assists the team in carrying out department responsibilities.
• Collaborates with others to support short and long-term goals and priorities for the department.
• Completes other projects and duties as assigned.

POSSESSES THE ABILITY TO:

• Develop rapport with internal and external contacts at all levels.
• Adhere to CalOptima Health’s policies and procedures.
• Adhere to state and federal laws such as the Health Insurance Portability and Accountability Act (HIPAA) which covers Protected Health Information (PHI).
• Create and innovate approaches to challenges and opportunities.
• Maintain accurate records and adhere to documentation standards.
• Work with appropriate departments to expedite the resolution of member concerns.
• Establish and maintain effective working relationships with CalOptima Health’s leadership and staff and external contacts.
• Communicate clearly and concisely, both orally and in writing, with individuals from varying cultures and ethnic backgrounds.
• 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 diploma or equivalent required.
• 2 years of experience in behavioral health, customer service, community service or other social service setting required.
• Have access to an approved means of transportation for work away from the primary office approximately 5% of the time.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.

PREFERRED QUALIFICATIONS:

• Bachelor's degree in Behavioral Health or related field preferred.
• Health maintenance organization (HMO), Medi-Cal, Medicare and health services experience preferred.
• Bilingual in English and in one of CalOptima Health's defined threshold languages (Spanish, Vietnamese, Arabic, Farsi, Korean, and Chinese) preferred.

KNOWLEDGE OF:

• Available health plans and CalOptima Health’s benefit structure.
• Issues that face members with behavioral health needs.
• 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.

DEPARTMENT(S): Behavioral Health Integration REPORTS TO: Supervisor, Behavioral Health FLSA STATUS: Non-Exempt SALARY GRADE: D - $21.15 - $30.67 ($44,000 - $63,800)

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._ _

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 by contacting Human Resources Disability Management at 657-900-1134.

Required Skills Required Experience