Inland Empire Health Plans
Location
Rancho Cucamonga, CA | United States
Job description
Job Requisition ID: 10537
Under the direction of the Behavioral Health & Care Management (BH CM) leadership, the Supervisor, Behavioral Health & Care Management, oversees the operational responsibilities of the Behavioral Health & Care Management department staff. Staff composition may include clinical and non-clinical positions. The role is responsible for monitoring performance of the team and individual Team Members, identification of process improvement areas, developing a team approach to problem solving and developing a cohesive team. Overall, responsibilities include ensuring timely completion and response for Behavioral Health & Care Management department functions including:
- Ensuring accurate completion of the authorization data entry tasks, continuity of care, and Behavioral Health authorization processes
- Referrals and calls
- Ensuring compliance with all regulatory and quality requirements, including but not limed to, screening, assessment, care planning, and follow-up.
1. Develop effective relationships with co-workers, direct reports, and community partners, modeling excellent interpersonal skills and collaboration in working toward job duties and goals.
2. Model the importance of Member experience and engagement and engage with other leaders in BH and CM and at IEHP in developing and implementing Member and Team Member experience improvement activities.
3. Work closely with the BH and CM leadership to develop effective behavioral health care management principles, processes, and workflows as well as monitor care management services to ensure compliance with all IEHP, state and federal regulatory requirements.
4. Monitor and provide direction to the BH and CM team to ensure implementation of timely processes and follow through of calls, task completion, care coordination and care management, including Complex Care Management responsibilities.
5. Proactively recognize problematic or risk areas and help develop effective and efficient solutions in conjunction with BH &CM Team Members.
6. Professionally represent the department at selected IEHP meetings including external events, as necessary.
7. Provide exemplary leadership and support for all assigned BH and CM Team Members ensuring Team Members are given every opportunity to succeed in their positions and are supervised in accordance with Department and Human Resources (HR) policies.
8. Discuss difficult or complex cases with Team Members, provide recommendations for further action, coach Team Members in addressing Member’s holistic needs.
9. Review and update departmental policies and procedures, as necessary.
10. Evaluate current programs for efficiency and program outcomes by analyzing specific data and providing improvement suggestions.
11. Assist in auditing services authorized by BH & CM leadership and submit statistical reports to managerial and director leadership as requested.
12. Work closely with management to coordinate daily staffing and coverage of the BH & CM Units.
13. Supervise and train BH & CM assigned Tam members including monitoring of performance standards.
14. Monitor and provide timely direction to BH & CM assigned team to ensure adherence to NCQA, CMS, DMHC and DHCS regulator standards ensuring delivery of high-quality, cost-effective services to Members.
15. Engage in direct care management activities when needed. Provide mentoring and clinical supervision of licensed and unlicensed Team Members when needed.
16. Assist in training of new staff members utilizing proficiency in all electronic medical management systems (e.g., MedHok, MediTrac, Super Search and Web Portal).
Leader: Administers Hires, Terminations, and Performance Reviews
Three (3) years of relevant progressive work experience in a healthcare setting is required. Working experience and knowledge in teams consisting of Behavioral Health, Care Management, and Team Members dedicated to addressing social determinants of health. Supervisory/lead capacity experience required.
Experience in a managed care organization servicing Medicaid and/or Medicare membership preferred.
Bachelor’s degree in a related field from an accredited institution required.
In lieu of a bachelor’s degree, one of the following applicable scenarios may be considered:
1. Candidate with an active, unrestricted, and unencumbered Registered Nurse (RN) issued by the California BRN without a bachelor’s degree will require four (4) years of additional relevant work experience. This experience is in addition to the minimum years listed in the Experience Requirements above.
2. Candidate with an active, unrestricted, and unencumbered Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians without a bachelor’s degree will require six (6) years of additional relevant work experience. This experience is in addition to the minimum years listed in the Experience Requirements above.
Internal Candidates Only: In lieu of the required degree, a minimum of five (5) years of IEHP work experience in Health Services division is required for this position. This experience is in addition to the minimum years listed in the Experience Requirements above.
Master’s degree from an accredited institution preferred.
Possession of one (1) of the following active, unrestricted, and unencumbered clinical licenses issued by appropriate California state board required:
- Vocational Nurse (LVN) license issued by the California Board of Vocational Nursing and Psychiatric Technicians.
- Registered Nurse (RN) license issued by the California BRN.
- Clinical Social Worker (LCSW) license or Marriage and Family Therapist (LMFT) license issued by the California Board of Behavioral Sciences
Yes, must have a valid California Driver's license and valid automobile insurance. Must qualify and maintain driving record to drive company vehicles based on IEHP insurance standards of no more than three (3) points.
Deep understanding and knowledge of:
- Behavioral health and substance use conditions, including acute and chronic management.
- Awareness of the impact of unmitigated bias and judgement on health with the; commitment to addressing both.
- Evidenced based communication such as Motivational Interviewing, or similar empathy-based communication strategies.
- Understanding and sensitivity to multi-cultural community
- Whole health and integrated principles and practices is preferred.
Skilled in the following areas:
- Problem-Solving: Identify and resolve problems, effective time management and the ability to work in a fast-paced environment.
- Report Analysis: Comprehend and analyze statistical reports, aggregate data, make recommendations.
- Effective engagement and skill development to support strong, cohesive, productive Teams.
- Effective written and oral communication.
- Informally and formally sharing expertise.
Proven ability to:
- Work as a member of a team, executing job duties and making skillful decisions.
- Function independently.
- Be a self-starter.
- Sufficiently engage Members and Providers.
- Show resilience to tolerate a moderate level of change and development around new models of care and care management practices.
The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.
A reasonable salary expectation is between $103,708.80 and $132,225.60, based upon experience and internal equity.
Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as “Great Place to Work.” With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, we’re ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.
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