Program Supervisor- Managed Care bei Pacific Clinics

About our Program:  

Enhanced Care Management (ECM) is a program within a far-reaching, multiyear plan to transform California's Medi-Cal system, known as California Advancing and Innovating Medi-Cal (CalAIM). Led by California's Department of Health Care Services, the goal of CalAIM is to help integrate Medi-Cal more seamlessly with other social services and help improve outcomes for the millions of Californians covered by Medi-Cal, especially those with the most complex needs. Customers enrolled in the ECM program receive comprehensive care management from a single System Navigator who coordinates all their health and health-related care, including physical, mental, and dental care, and social services. ECM makes it easier for customers to get the right care at the right time in the right setting and receive comprehensive care that goes beyond the doctor’s office or hospital. Come join our team, partnering with managed care health plans, and change the landscape of Behavioral Health and integrated care in our state!

Who We Are 

Pacific Clinics is California's largest community-based nonprofit provider of behavioral and mental health services and support. Our team of more than 2,000 employees speaks 22 languages. They are dedicated to offering hope and unlocking the full potential of individuals and families through culturally responsive, trauma-informed, research-based services for individuals and families from birth to older adults. 

Who We Serve 

Pacific Clinics serves children, transitional-age youth, families, adults, and older adults. We offer a full range of mental and behavioral health services, foster care and social services, housing, continuing adult education and early childhood education programs to Medi-Cal-eligible individuals and families throughout Alameda, Contra Costa, Fresno, Kings, Los Angeles, Madera, Orange, Placer, Riverside, Sacramento, San Bernardino, San Francisco, Santa Clara, Solano, Stanislaus, Stockton, Tulare and Ventura Counties.   

Compensation We Offer

•  The initial compensation for this position ranges from $68,640.00 -$84,418.54 per year.
•  Salary is dependent on commensurate experience above the minimum qualifications for the role and internal equity considerations.
•  The salary may also vary if you reside in a different location than the location posted. 
•  8% License Differential for LMFT, LCSW, LPCC, PsyD. and select Peer Certifications. 
• 7.5% Bilingual Differential for qualified positions

Benefits We Offer

•  Benefits eligibility starts on day ONE! 
•  We Offer Comprehensive Medical, Dental & Vision benefits, Voluntary Life Insurance, Flex Spending, Health Savings Account, EAP, and more!   
•  Employer Paid Long-Term Disability & Basic Life Insurance
•  401K Employer Match up to 4%
•  Competitive Time Off Plans (may vary by employment status)
•  Employee engagement and advocacy opportunities to advance our justice, equity, diversity, and inclusion agenda across our Agency and throughout the communities we serve.

JOB SUMMARY

Works within the vision, mission, and philosophy of the agency. Under direction of the Program Manager- CalAIM, hires, develops, trains, manages, and retains program staff and team(s) to ensure customer satisfaction and culturally competent service delivery consistent with managed care requirements. Functions as the liaison between team, agency, and community partners. Ensures provision of high-quality service by program staff through administrative supervision and monitoring of program KPIs.

RESPONSIBILITIES AND DUTIES

Clinical Care Management

1. Works with Program Manager to ensures effective quality managed care services delivery for assigned health plan members.
2. Ensures and monitors satisfaction and defined outcome achievement for health plan members.
3. Collaborate with licensed staff to provide effective crisis and risk prevention and management.
4. Provides 24/7 availability as needed. Culturally responsive to internal and external customers and ensures customer voice.
5. Provides direct services to health plan members, as support to the direct service staff, to ensure smooth delivery of service.
6. Responsible for managing referrals (e.g., electronic, telephonic, manual) and assigning accordingly
7. May be responsible for case load.
8. Ensures customer voice and is culturally responsive to internal and external customers.
9. Consults with clinical and medical staff about treatment plans, youth and family issues, progress and needs.

Program & Fiscal Management

1. Oversees and supports the assessment process and implementation of treatment plans consistent with managed care requirements.
2. Manages day-to-day provision of services of team members (e.g., System Navigators).
3. Work with Program Manager to ensures staff engage health plan members for enrollment and other revenue related activities meet or exceed revenue forecasts to ensure viable programming.
4. Ensures compliance with all policy and procedures including adherence to all licensing, quality, Information Technology (IT), Human Resources (HR), compliance and regulatory standards.
5. Oversee clinical documentation meets both agency and payor standards, ensuring audit ready charts and continuous quality improvement.
6. Effectively manage individual and program utilization rates
7. Responsible for managing team operation metrics at appropriate frequency to effectively manage the program, staffing pattern, and clinical needs
8. Works collaboratively with managerial peers to develop and improve program delivery and ensure adherence to fiscal requirements.

Personnel Management

1. Participates in staff development; hires, coaches, mentors, supervises, conducts direct field observations, trains, disciplines, and terminates.
2. Leads and manages change.
3. Proactively identifies potential conflicts and facilitate resolution.

External Liaison

1. Work with Program Manager to ensure effective coordination of services for health plan members with other providers, both internal and external, by supporting the development of constructive relationships and problem-solving barriers.
2. Provides outreach to the community regarding managed care and behavioral health.

Quality Assurance and Improvement

• Initiates and participates in organizational quality improvement efforts. Lead and/or delegate work groups to respond to program development needs.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential job functions.

MINIMUM EDUCATION AND/OR EXPERIENCE

A combination of education and experience equivalent to a:

• Bachelor of Arts or Science (B.A./B.S.) or associate degree in related field and 3 additional years of experience in addition to minimum experience requirement.
• Bachelors in behavioral science, public health, nursing, preferred. 
• Minimum of three (3) years of experience in primary care, public health, social or mental health services delivery.
• Knowledge of whole-person or integrated care preferred.

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Equal Opportunity Employer

We will consider for employment qualified Applicants with Criminal Histories in a manner consistent with ordinance 184652 Sec.189.04 (a) and San Francisco Police Code, Article 49. Section 4905.