Managed Care Outreach Specialist
San Jose, CA San Jose, CA Full-time Full-time $26.
44 - $30.
57 an hour $26.
44 - $30.
57 an hour 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 speak 22 languages and 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 Clinic's School Based Intervention Team (SBIT) serves children, adolescents, families, adults, and educators across California.
We offer a wide range of tiered mental and behavioral health services focusing on partnering with local county offices of education and school districts.
What We Offer Pay Range:
$26.
44 to $30.
57 per hour.
Compensation may vary based on skills, experience, education, and location.
We Offer Medical, Dental & Vision benefits, retirement options, Flex Spending, EAP, and more! Employee engagement and advocacy opportunities to advance our justice, equity, diversity, and inclusion agenda across our Agency and throughout the communities we serve.
About our Program:
Pacific Clinics' School Based Intervention Teams (SBIT) provide tiered behavioral health services across various locations (e.
g.
, school sites, community, and via telehealth).
SBIT services are delivered within a Multi-Tiered Systems of Support (MTSS), with a focus on Positive Behavioral Intervention Supports (PBIS), Wellness Center implementation, Social Emotional Learning, Restorative Practices, various evidence-based practices to support Community School efforts.
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 1.
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.
2.
Assists with the implementation of internal process that ensures the accountability for various fiscal and administrative operations.
3.
Review TEL List.
4.
Assign staff to clients in HHE and HHP.
5.
Deactive excluded referrals.
6.
Communicate deactivated enrollees via approved business processes.
7.
On-going review of medi-cal status and communicate to clinical staff and Billing.
Shared Services Coordination 1.
Serves as liaison for shared services; coordinates with other departments to meet various reporting and compliance needs.
Finance/Billing (UM) 1.
Manage authorizations (i.
e.
, initial, renewal) with payors; implement processes with program managers and client services to prevent lapse of authorizations.
2.
Consults with finance department and program managers/directors about claims and billing issues and concerns.
Quality Assurance 1.
Assists with program audits, and customer contact to support clinical program (e.
g.
, intake, discharge).
2.
Support regional QA for CQI activities and compliance.
OTHER DUTIES AND RESPONSIBILITIES 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.
JOB SPECIFIC COMPETENCIES 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 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.
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).
Practice self-care, remain aware that others may be contending with stress, and treat 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 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).
.
Estimated Salary: $20 to $28 per hour based on qualifications.
44 - $30.
57 an hour $26.
44 - $30.
57 an hour 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 speak 22 languages and 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 Clinic's School Based Intervention Team (SBIT) serves children, adolescents, families, adults, and educators across California.
We offer a wide range of tiered mental and behavioral health services focusing on partnering with local county offices of education and school districts.
What We Offer Pay Range:
$26.
44 to $30.
57 per hour.
Compensation may vary based on skills, experience, education, and location.
We Offer Medical, Dental & Vision benefits, retirement options, Flex Spending, EAP, and more! Employee engagement and advocacy opportunities to advance our justice, equity, diversity, and inclusion agenda across our Agency and throughout the communities we serve.
About our Program:
Pacific Clinics' School Based Intervention Teams (SBIT) provide tiered behavioral health services across various locations (e.
g.
, school sites, community, and via telehealth).
SBIT services are delivered within a Multi-Tiered Systems of Support (MTSS), with a focus on Positive Behavioral Intervention Supports (PBIS), Wellness Center implementation, Social Emotional Learning, Restorative Practices, various evidence-based practices to support Community School efforts.
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 1.
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.
2.
Assists with the implementation of internal process that ensures the accountability for various fiscal and administrative operations.
3.
Review TEL List.
4.
Assign staff to clients in HHE and HHP.
5.
Deactive excluded referrals.
6.
Communicate deactivated enrollees via approved business processes.
7.
On-going review of medi-cal status and communicate to clinical staff and Billing.
Shared Services Coordination 1.
Serves as liaison for shared services; coordinates with other departments to meet various reporting and compliance needs.
Finance/Billing (UM) 1.
Manage authorizations (i.
e.
, initial, renewal) with payors; implement processes with program managers and client services to prevent lapse of authorizations.
2.
Consults with finance department and program managers/directors about claims and billing issues and concerns.
Quality Assurance 1.
Assists with program audits, and customer contact to support clinical program (e.
g.
, intake, discharge).
2.
Support regional QA for CQI activities and compliance.
OTHER DUTIES AND RESPONSIBILITIES 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.
JOB SPECIFIC COMPETENCIES 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 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.
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).
Practice self-care, remain aware that others may be contending with stress, and treat 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 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).
.
Estimated Salary: $20 to $28 per hour based on qualifications.
|
|
 | |
