Program Manager- Managed Care

Program Description:
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 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 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.

What We Offer

• Compensation for this role pays up to $85,050.01-$104,600.79. Compensation will vary based on qualifications, skills, experience, and geographic location. The salary range may vary if you reside in a different location or state than the location posted.
  
  • +8% licensure incentive / +7.5% language incentive (Depending on program needs)
  • Hybrid
• 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.

JOB SUMMARY

Works within the vision, mission, and philosophy of the agency. Under direction of the AD- 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

• Ensures effective quality managed care services delivery for assigned health plan members.
• 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.
• Collaborate with licensed staff to provide effective crisis and risk prevention and management.
• Provides 24/7 availability as needed. Culturally responsive to internal and external customers and ensures customer 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 budget targets, 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 need.
• 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 Liaison

• 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.
• 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.

OTHER DUTIES AND RESPONSIBILITIES

• Driving to appointments with clients or other key contacts.
• Performs other responsibilities, as assigned, to support specific department/business 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 the essential functions.

MINIMUM EDUCATION AND/OR EXPERIENCE

• Bachelor's degree in social work, Marriage and Family Counseling, Psychology, Public Health, Health Administrator or related field preferred
• At least two (2) years supervisory experience required.
• Experience in Social Determinants of Health- e.g., housing- preferred
• Equivalent education and experience will be considered.
• Knowledgeable about integrated or whole person care 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.