Behavioral Health Program Manager - Clinical Oversight
ABOUT US: The Alliance is an award-winning regional not-for-profit health plan. We currently serve over 350,000 members in Santa Cruz, Monterey and Merced counties. We are a group of dedicated individuals driven by our mission of providing accessible, quality health care that is guided by local innovation. We are value-based, guided by the following:
• Culture: We strive for a respectful, diverse, professional and fun workplace. • Customer Service: Our customers’ satisfaction is our highest priority. • Excellence: We value and continuously improve quality in our services. • Innovation: We leverage local talent to create solutions. • Integrity: We tell the truth and do what we say we will do. • Partnership: We collaborate with others for strong solutions. • Stewardship: We manage responsibly, and earn the trust of partners and regulators.
We approach health care with innovative methods, and include care management of high utilizers, and social determinants of health in our strategic planning. We strive to develop a regional health care system that delivers quality, high value health care, and we engage actively with our community partners, agencies and stakeholders to share this responsibility.
RESPONSIBILITIES: Under direction, this position manages day-to-day operational issues related to Behavioral Health activities and provides related clinical and operational guidance; provides operational oversight of vendor activities and performance; supports clinical practice oversight, research, and operational processes based on Medi-Cal, Knox-Keene and other regulatory and accreditation requirements, and performs clinical audits to ensure compliance with requirements; provides programmatic support to the Behavioral Health Director; and performs other duties as assigned.
YOU WILL BRING: • Thorough knowledge of the principles and practices of clinical research and assessment • Working knowledge of and proficiency with Windows based PC systems and Microsoft Word, Excel, PowerPoint and Outlook • Working knowledge of: - The array of mental health and substance use disorder services - The principles and practices of managed care, utilization management and/or case management - Research, analysis, and reporting tools and methods - Relevant healthcare regulatory and accreditation requirements, such as Medi-Cal, Knox-Keene and NCQA • Some knowledge of the tools and techniques related to program and project management • Ability to: - Audit, analyze and assess medical records and other health care data - Utilize evidence based practice guidelines in the evaluation and management of vendor performance for utilization management, care management and transitional care activities - Develop and implement projects, systems, programs, policies and procedures - Act as a technical resource and explain regulations, processes, and programs related to area of assignment - Provide leadership and facilitate meetings - Foster effective and collaborative working relationships, influence others, and build consensus with individuals at all levels in the organization - Recognize and effectively utilize the most appropriate mode of communication based upon the circumstances of the situation - Professionally direct and manage difficult callers or other types of challenging interactions through the utilization of interpersonal intervention skills - Utilize good judgment and tact when interacting with health care providers, members and other stakeholders - Work independently, manage assigned workload, make decisions related to areas of functional responsibility, and recognize issues requiring escalation - Identify issues, conduct research, gather and analyze information, reach logical and sound conclusions, and make recommendations for action - Effectively, clearly and independently document, summarize and resolve complex issues - Analyze and interpret legal and contractual language - Analyze data and prepare written and oral reports - Develop training materials, in conjunction with Training and Development staff, and conduct training - Create forms, correspondence, and other program documents • Education and Experience: - Current and unrestricted license as a Registered Nurse, Licensed Clinical Social Worker, Marriage and Family Therapist, Licensed Professional Clinical Counselor, or Psychologist issued by the State of California - Three (3) years of behavioral health clinical experience or an equivalent combination of education and experience which would provide the required knowledge, skills and abilities may be qualifying
BENEFITS: • Medical, Dental and Vision Plans • Generous Paid Time Off • 11 Paid Holidays per Year • 401(a) Retirement Plan • 457 Deferred Compensation Plan • Tuition Reimbursement • Costco Membership Reimbursement • Health and Wellness Program • Fresh Fruit Delivery • Electric Vehicle Charging Stations • And many more! (https://ccah-alliance.silkroad.com/map_images/main/SiteGen/ccahext/Content/Uploads/Unplaced_Documents/Benefits_Summary.pdf
?For a complete position description and to apply online, please visit our careers website at https://ccah-alliance.silkroad.com
If this sounds like an opportunity that you or someone you know may be interested in we invite you to apply! Applicants must be currently authorized to work in the United States on a full-time basis.
The Alliance is an equal employment opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender perception or identity, national origin, age, marital status, protected veteran status, or disability status.