Job Description
Department(s): Behavioral Health Integration
Reports to: Sr Manager II
FLSA status: Non-Exempt
Salary Grade: M - $85,000 - $141,086
Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is on Thursday, February 29, 2023 at 11:59 PM. Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.
About CalOptima Health
Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health!
About the Position
The Supervisor Behavioral Health (Call Center/Clinical) will be responsible for the daily operations within the CalOptima Health Behavioral Health (BH) Call Center and Clinical teams and will work under the direction of the Senior Manager II. The incumbent will ensure Medi-Cal and Medicare members receive appropriate BH services, including BH Clinical screenings, securing BH appointments for members, following up with members before and after appointments, providing member information, referring to community resources, assisting members in navigating the mental health system of care and Behavioral Health Case Management. The incumbent will be accountable for establishing and achieving quality and productivity standards for the teams and for ensuring compliance with department policies and procedures. Additionally, the incumbent will coordinate and support CalOptima Health's participation with external stakeholders in different activities, including health networks and community partners.
Duties & 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.
• Oversees the process, management and reporting of the team's activities.
• Provides supervision and clinical consultation to the team.
• Supports licensed Clinicians as needed by helping to complete telephone BH assessment and triage for members with BH needs.
• Assists escalated callers as needed.
• Works with BH leadership to develop, implement and refine regular reporting metrics to measure productivity and process outcomes.
• Implements process improvements as identified and approved by BH leadership.
• Works cross functionally to review and revise policies and procedures to ensure National Committee for Quality Assurance (NCQA), Department of Managed Health Care (DMHC), Centers for Medicare & Medicaid Services (CMS) and Department Health Care Services (DHCS) regulatory compliance.
• Assists with developing, documenting and updating regulatory and departmental compliance desktop policies and 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.
• Completes other projects and duties as assigned.

Experience & Education:

• Master's degree in Social Work, Clinical Psychology, Marriage and Family Therapy or related field of study required.
• Current unrestricted California License required: Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC) or Licensed Psychologist (PhD, PsyD).
• 4 years of BH clinical experience required.
• An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

Preferred Qualifications:

• Certified Case Manager (CCM).
• 2 years call center experience.
• 2 years BH case management experience.
• 1 year of supervisory experience.
• Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).
• Experience in managed care environment, with specific experience in managing the BH benefit for members covered by Medicare, Medi-Cal and/or Drug Medi-Cal.

Physical Demands and Work Environment:
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Physical demands: While performing duties of the job, employee may be required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms and must occasionally lift office supply boxes. Employee must occasionally move health education materials, boxes, and supplies, as well as transport materials in and out of offices for health fairs and community classes and events. Employee must be able to communicate, particularly for regular phone use, in meetings and face-to-face interaction.

• Work Environment: Typical office environment with minimal to moderate noise levels and controlled office temperatures.

About our Benefits & Wellness options:
At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.
CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.
CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health 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 Health 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.
Job Location: Orange, California
Position Type:
To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4543
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