The Program Manager (PM) Sr. is responsible for regulatory requirements governing authorization processing, monitoring utilization patterns, and developing behavioral health utilization management work plan. The incumbent works under the direction of the Director of Behavioral Health Services (Integration), Medical Director of Behavioral Health and/or other department leadership to support the department’s UM activities. The incumbent will also play a vital role in the program design, development, and implementation of behavioral health related programs. The position will be responsible for the overall direction, coordination, implementation, execution, control and completion of tasks supporting new program development.
POSITION RESPONSIBILITIES:
- Assists with the collection, monitoring, and analysis of UM indicators and activities.
- Subject Matter Expert (SME) in UM process for staff within the department.
- Reviews workflows, procedures, and/or policies and recommends or changes as appropriate to ensure timely, efficient, and effective outputs.
- Obtains records and information from BH providers for UM review.
- Analyzes metrics for trends and variables and identifies areas for improvement.
- Implements process improvements as identified and approved by the Director.
- Leads program development activities for various behavioral health programs.
- Collaborates with department analyst in the development of outcome reports for programs supported by the department.
- Maintains current knowledge of applicable regulations or clinical guidelines related to program development.
- Other projects and duties as assigned.
Required Skills
- Communicate clearly and concisely, both verbally and in writing, including presentations.
- Systematically evaluate work and apply skills to continuously improve processes.
- Manage multiple deadlines in a fast-paced environment.
- Initiate and follow through on projects with minimal supervision.
- Think critically to solve problems effectively.
- Work independently and as an effective member of a team.
- Demonstrate excellent analytical, interpersonal, organizational, and writing skills.
- Provide innovative approaches to challenges and opportunities.
- Utilize and access computer programs and appropriate software (e.g. Microsoft Office; Word, Excel, Outlook, PowerPoint) and job specific applications such as Guiding Care and MCG Health CareWeb.
Required Experience
EXPERIENCE & EDUCATION:
- Bachelor’s degree in a behavioral health related field required; Master’s degree in Health Administration, Social Work, Marriage and Family Therapy, Public Health, or other related degree preferred.
- 2 years’ experience in new program development for vulnerable populations, including strategic planning for a start-up program and implementing the program required.
- 2 years’ experience and aptitude for working in a highly matrixed, mission-driven organization required.
- 4 years’ experience working in a managed care environment, with specific experience in behavioral health utilization management preferred.
- Experience in a government or public environment strongly preferred.
KNOWLEDGE OF:
- Detailed knowledge of departmental procedures, policies, and clinical guidelines relative to behavioral health utilization management and authorization process.
- Culture and needs of the socially and ethnically diverse population CalOptima serves.
- Principles and practices of health care, health care systems, and managed care.
- Medi-Cal benefits and regulations.
- Behavioral health and experience in developing, implementing and evaluating evidenced-based programs.
- Managed care, Medicare, and Medi-Cal, with some experience in applying the appropriate regulations and guidelines to behavioral health care services.
- Principles of managed health care service delivery.
Grade: O
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