Job Opportunities in United States
October 28, 2024
Pacific Clinics
Pasadena
FULL TIME
Managed Care Outreach Specialist
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
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 (Cal AIM). Led by California's Department of Health Care Services, the goal of Cal AIM 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!
JOB SUMMARY
Works within the vision, mission, and philosophy of the agency. Report to the CPM or Program Administrator and support them in administration functions of the program. This position plays a critical role engaging potential customers in managed-care and similar programs (e.g., CCBHC). Must be adept in a fast-paced environment with high-volume referrals.
RESPONSIBILITIES AND DUTIES
Administrative
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. All employees are responsible for keeping job requirements up to date. This can include but are not limited to certifications, licensure, and maintaining a clear criminal record.
MINIMUM EDUCATION AND/OR EXPERIENCE
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.
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 $26.57-$32.68 per/HR.
- 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.
- 7.5% Bilingual Differential for qualified positions
- 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 3.5%
- 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.
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 (Cal AIM). Led by California's Department of Health Care Services, the goal of Cal AIM 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!
JOB SUMMARY
Works within the vision, mission, and philosophy of the agency. Report to the CPM or Program Administrator and support them in administration functions of the program. This position plays a critical role engaging potential customers in managed-care and similar programs (e.g., CCBHC). Must be adept in a fast-paced environment with high-volume referrals.
RESPONSIBILITIES AND DUTIES
Administrative
- Provides administrative support functions and tasks to ensure programs meet the customer, referral, payor, and staff support needs required to meet agency and contract expectations.
- Assists with the implementation of internal process that ensures the accountability for various fiscal and administrative operations.
- Review TEL List.
- Assign staff to clients in HHE and HHP.
- Deactive excluded referrals.
- Communicate deactivated enrollees via approved business processes.
- On-going review of Medi-Cal status and communicate to clinical staff and Billing.
- Serves as liaison for shared services; coordinates with other departments to meet various reporting and compliance needs.
- Manage authorizations (i.e., initial, renewal) with payors; implement processes with program managers and client services to prevent lapse of authorizations.
- Consults with finance department and program managers/directors about claims and billing issues and concerns.
- Assists with program audits, and customer contact to support clinical program (e.g., intake, discharge).
- Support regional QA for CQI activities and compliance.
- Practice self-care, remain aware that others may be contending with stress, and treat other with grace.
- Performs other responsibilities, as assigned, to support specific department/business needs.
- Contributes to Team Performance
- Manages Multiple Priorities Focus
- Business Acumen
- Intermediate to advanced excel.
- Highly organized and detailed oriented
- Flexible & adaptable
- Analytical ability to analyze detail to inform actions.
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. All employees are responsible for keeping job requirements up to date. This can include but are not limited to certifications, licensure, and maintaining a clear criminal record.
MINIMUM EDUCATION AND/OR EXPERIENCE
- High School Diploma or equivalent degree in a related field or equivalent work experience required.
- Six (6) months of experience in an administrative position or Mental Health field required.
- One (1) year experience in an administrative position or Mental Health field preferred.
- Experience in fast-paced environment with rapid changes.
- Data management and visualization experience (preferred).
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.
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