The Supervisor, Behavioral Health (BH) is responsible for the daily operation of Member Liaison Specialists (MLS) and Clinician activities. He/She will ensure Medi-Cal, One Care, and One Care Connect members receive appropriate BH care management needs, which includes, but is not limited to, BH Clinical screenings, securing BH appointment for members, following up with members before and after appointment, providing member information and referring to community resources, and assisting member in navigating the mental health system of care. The Supervisor is accountable for establishing and achieving quality and productivity standards for the teams and for ensuring compliance with department policies and procedures. He/She will provide clinical support for the CalOptima BH Phone Line triage team. He/She will work under the direction of the Clinical team Manager in partnership with the Clinical Operations Director and/or other department leadership to support department goals. The Supervisor is a resource for CalOptima providers, health networks and community partners.
Oversees the process, management and reporting of MLS activities.
Provides first-level supervision and clinical consultation to MLS and Clinicians for difficult or complex cases.
Supports Clinicians as needed by helping to complete telephonic behavioral health assessment and triage for members with behavioral health needs.
Provides first-level assistance to escalated callers wanting to speak with a supervisor.
Oversees and coordinates the LOA request process.
Assists with coordination of complex referrals to County Mental Health Plan for members who meet criteria for specialty mental health services.
Works with the Manager to develop, implement and refine regular reporting metrics to measure MLS productivity and process outcomes.
Implements process improvements as identified and approved by the Manager.
Works with the Manager to review and revise policies and procedures to ensure NCQA, DMHC, CMS, and DHCS regulatory compliance.
Assists with developing, documenting and updating desktop procedures.
Builds, maintains, and enhances relationships with the County of Orange, providers, health networks, community-based organizations, and other key stakeholders.
Maintains knowledge of current regulatory requirements and industry trends.
Serves as a resource for CalOptima providers, members and community partners.
Other projects and duties as assigned.
Communicate clearly and concisely, both verbally and in writing, including presentations.
Think critically and apply analytical skills as needed to solve problems and determine best course of action.
Establish and maintain effective working relationships with staff at all levels, providers, other program or agency representatives, and the general public.
Systematically evaluate work and apply skills to continuously improve processes.
Provide excellent customer service.
Manage multiple deadlines in a fast-paced environment.
Initiate and follow through on projects with minimal supervision.
Work well as part of a team to manage/lead multiple projects simultaneously.
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:
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.
Health Plan, Hospital and Medical Group operations and strategies.
Community-based organizations, agencies and community services.
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.
Job Location Orange, California, United States Position Type Full-Time/Regular