Supervisor, Behavioral Health (Utilization Management)

Job Description:

Supervisor, Behavioral Health (Utilization Management)

Description

Supervisor, Behavioral Health (Utilization Management)

CalOptima Health is seeking a highly motivated an experienced Supervisor, Behavioral Health (Utilization Management) to join our team. The Supervisor Behavioral Health (Utilization Management) will be responsible for the daily operation of Behavioral Health Integration (BHI) Utilization Management (UM) functions. The incumbent will oversee the benefit's prior authorization, concurrent review processes and transition of care. The incumbent will be responsible for the direct supervision and oversight of the BHI staff. The incumbent will work under the direction of the Sr Manager II to implement processes to ensure effective delivery of behavioral health services. The incumbent will be accountable for establishing and achieving quality and productivity standards and ensuring compliance with CalOptima Health's policies and procedures. The incumbent will collaborate with other internal CalOptima Health departments to ensure all regulatory requirements are met. The incumbent will interact with contracted organizations and providers, health networks and other stakeholders in a manner that promotes collaborative working relationships.

Position Information:
Department: BHI - BH Utilization Management
Salary Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615)
Work Arrangement: Full Telework**This position is eligible for telework in California.**

Duties & Responsibilities:
50% - Program Support
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.
Assists the Sr Manager II as needed to ensure departmental and agency goals are met.
Participates and prepares for regular internal and external audits.
Provides clinical support for cases with complex behavioral health needs.
Participates in the development, implementation and improvement of departmental policies, procedures and workflows.
Develops and prepares reports to meet internal, regulatory, contractual and accreditation requirements.
Maintains current knowledge of regulatory requirements pertinent to BHI UM which includes the Department of Health Care Services (DHCS), Centers for Medicare & Medicaid Services (CMS), Managed Risk Medical Insurance Board (MRMIB) and Department of Managed Health Care (DMHC).
Ensures compliance with federal, state and county contracts and/or Memorandum of Understanding (MOUs) and other requirements set forth by regulatory agencies or funding sources specific to behavioral health care services.
Acts as a liaison to community based and governmental providers that serve members.
45% - Supervision
Supervises and assists with hiring, training, reviewing and setting goals for department and staff.
Oversees and monitors the prior authorization and concurrent review process of the benefit and regulatory compliance.
Provides direct oversight of the day-to-day operations of the behavioral health benefit.
Facilitates staff meetings, including individual supervision.
Provides coverage and expertise for other teams within the BHI UM department.
Serves as a subject matter expert (SME) to departmental staff, internal departments and affiliated health networks regarding authorization rules and processes.
Identifies and conducts performance feedback and/or counseling/corrective action meetings with the assistance of Human Resources as necessary.
5% - Completes other projects and duties as assigned.

Minimum Qualifications:
Master's degree in social work, clinical psychology, marriage and family therapy or related field or graduation from an accredited School of Nursing required.
3 years of behavioral health experience (post licensure) required.
2 years of supervisory/management experience over a team(s) of staff with responsibilities to include:
Providing lead work direction and training
Leading staff meetings
Setting goals
Assigning tasks to employees
Overseeing day-to-day operations
Providing feedback to leadership on staff/team performance
Experience in behavioral health audits, including CMS, DHCS, DMHC and NCQA 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:
2 years of utilization management (UM) experience.
2 years of managed care experience.

Required Licensure / Certifications:
Current and unrestricted California Board Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed professional Clinical Counselor (LPCC), Licensed Clinical Psychologist or an active Registered Nurse (RN) license to practice in the state of California required.

Knowledge & Abilities:
Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
Work independently and exercise sound judgment.
Communicate clearly and concisely, both orally and in writing.
Work a flexible schedule; available to participate in evening and weekend events.
Organize, be analytical, problem-solve and possess project management skills.
Work in a fast-paced environment and in an efficient manner.
Manage multiple projects and identify opportunities for internal and external collaboration.
Motivate and lead multi-program teams and external committees/coalitions.
Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Physical Requirements (With or Without Accommodations):
Ability to visually read information from computer screens, forms and other printed materials and information.
Ability to speak (enunciate) clearly in conversation and general communication.
Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions.
Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
Lifting and moving objects, patients and/or equipment

Work Environment:
If located at the 500, 505 Building or a remote work location:
Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
There are no harmful environmental conditions present for this job.
The noise level in this work environment is usually moderate.

If located at PACE:
Work is typically indoors in a clinical setting serving the frail and elderly.
There may be harmful or hazardous environmental conditions present for this job.
The noise level in this work environment is usually moderate to loud.

If located in the Community:
Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed.
Employee will occasionally work outdoors in varied temperatures.
There may be harmful or hazardous environmental conditions present for this job.
The noise level in this work environment is usually moderate to loud.

About CalOptima Health:CalOptima Health is the single largest health plan in Orange County, serving 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. We are continuing to build a culture that promotes diversity and inclusion within our community where employees have a sense of belonging, and are valued for their ideas, contributions, and their unique individual perspectives they bring. CalOptima Health has been recognized as one of Orange County's best places to work, so we know there is something special about our organization. It is why people choose to work here and why they choose to stay!

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 Monday or 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. For those who are interested in additional retirement savings, employees have access to 457(b) retirement plans with pre/post-tax contribution options.For more information, please click on the 2024 CalOptima Health Benefits Guideand our 2025 CalOptima Health Benefits Guide regarding our comprehensive benefits and wellness package.

IMPORTANT APPLICATION INFORMATION AND INSTRUCTIONS
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 November 8, 2024 at9:00 PM (PST).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.

The selection process may include, but is not limited to, a skills assessment, phone screen and interview.
The successful candidate will be required to undergo a reference / background check (to include a conviction record) and if applicable also pass a post-offer pre-employment medical examination (which will include a drug screening). Internal CalOptima Health applicants should apply through InfoNet.

Communication regarding your application will be sent to the email address listed on your application.Please check your email, including your SPAM folder, regularly throughout the recruitment process. You can also visit your candidate portal to receive the most up to date status of your application.

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 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 at (714) 246-8400 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.

To apply, visit: https://jobs.caloptima.org/jobs/supervisor-behavioral-health-utilization-management-500-city-parkway-west-california-united-states





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