Clinical Program Manager, Managed Care

Program Description: Pacific Clinics is expanding its service offering to include Non-Specialty Mental Health - outpatient mental health services for individuals of all ages with mild to moderate mental health needs.

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 $98,456.02 -$121,088.49 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. Hires, develops, trains, manages, and retains clinical program staff and a clinical team(s) to ensure customer satisfaction and culturally competent service delivery. Functions as the liaison between team, payers, and community partners. Provides fiscal stewardship of team, acts as a bridge between fiscal and other departments. Ensures provision of high quality service by program staff.

RESPONSIBILITIES AND DUTIES

Clinical Care Management

Ensures effective quality clinical services delivery for assigned healthplan members.

Develops, interprets and ensures consistent implementation of clinical program philosophy, objectives, standards, policies, procedures and practices.

Analyzes and integrates the use of outcome data to improve clinical service delivery within assigned team.

Ensures and monitors satisfaction and defined outcome achievement for health plan members.

Provides effective crisis and risk prevention and management.

Provides 24/7 availability as needed. Culturally responsive to internal and external customers, and ensures family voice.

Provides direct services to health plan members, as support to the direct service staff, to ensure smooth delivery of service.

Responsible for managing referrals (e.g., electronic, telephonic, manual) and assigning accordingly

Program & Fiscal Management

Manages day-to-day operations including utilization of all administrative electronic systems, human, and other resources.

Ensures staff engage health plan members for enrollment and other revenue related activities meet or exceed revenue forecasts to ensure viable programming.

Ensures compliance with all policy and procedures including adherence to all licensing, quality, Information Technology (IT), Human Resources (HR), compliance and regulatory standards.

Ensures clinical documentation and quality assurance meets both agency and payor standards, ensuring audit ready charts and continuous quality improvement.

Effectively manage individual and program utilization rates

Implement scaffolded structures and process to address immediate needs (initial implementation) and long-term solution (full implementation)

Responsible for managing operations metrics at appropriate frequency to effectively manage the program, staffing pattern, and clinical needs

Advocate for business needs to balance agency process and alternative payor requirements

Works collaboratively with managerial peers to develop and improve program delivery and ensure adherence to fiscal requirements.

Personnel Management

Participates in staff development; hires, coaches, mentors, supervises, conducts direct field observations, trains, disciplines, and terminates

Leads and manages change

Proactively identifies potential conflicts and facilitate resolution

External Liason

Ensures 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.

Partners with health plans referring departments, agencies and the community to ensure comprehensive care.

Provides outreach to the community regarding managed care and behavioral health.

Quality Assurance and Improvement

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

JOB SPECIFIC COMPETENCIES

• Timely Decision Making and Quality (Decision Quality)
• Conflict Resolution
• Encouraging Customer Focus
• Developing Direct Reports and Others (Developmental Orientation)
• Highly organized in fast paced program
• 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

• Master's Degree (MA/ MS) required.
• Behavioral Health Experience
• Managed Care (e.g., Patient engagement conversion, utilization management)
• Primarily Children/Adolescents; prefer-all age range
• New program start-up (preferred)

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.