Sr. Manager of Behavioral Health Access

Overview

To direct and coordinate medically necessary behavioral health treatment services for members seeking behavioral health services. Oversees operations of Behavioral Health Call Center and staffing. Oversees staff to ensure the coordination of care for members seeking behavioral health services for both carved in and carved out services. Ensures regulatory compliance with call center performance requirements.

• Manages the day-to-day operations of the behavioral health call center.
• Builds strong, competent staff to enhance the member experience, which may include supporting access to care and ensuring closed loop referrals.
• Accountable for developing performance standards and implementing monitoring mechanisms to ensure service level expectations are met.
• Responsible for program evaluation and oversees training, creation of policies and procedures, and facilitation of meetings and projects.
• Plans, implements and provides ongoing direction for quality assurance and quality improvement activities of the Behavioral Health member experience team.
• Works with department leadership and internal stakeholders to ensure Behavioral Health Department is meeting intended goals in support of the member experience.
• Monitors and evaluates the efficiency and effectiveness of service delivery methods and procedures.
• Represents the Behavioral Health Department at meetings and maintains relationships with internal and external stakeholders, community partners, and regulatory agencies.
• Ensures regulatory compliance and performance standards for the Call Center.
• Provides day-to-day oversight and support of the Behavioral Health Access staff.
• Establishes operational workflows, best practices and continuous improvement activities.
• Participates in the development of departmental policies and procedures.
• Assists with development of system changes or upgrades as needed.
• Facilitates and/or attends appropriate committees, meetings, and trainings.
• Participates in the development and revision of member materials.
• Provides backup on phones as needed including the screening of members using proscribed screening tools and directs members to appropriate providers.
• Assists with compliance of DHCS, DMHC, CMS, and NCQA requirements and standards.
• Oversees review and processing of daily, weekly and monthly access line reporting to ensure timely access, closed loop referrals, and call performance measures are met.
• Oversees operations of staff managing specialized case load of members with behavioral health needs which interfere with positive healthcare outcomes.
• Collaborates and consults with care providers, member, and/or the multidisciplinary care team to assist in understanding the members behavioral health needs.
• Acts as a support/resource to others within the organization for behavioral health cases.
• Knowledge of and ability to coordinate with multiple systems of care including county-based behavioral health services.
• Functions collaboratively in a team environment.
• Utilizes best practices in coordination of behavioral health services in accordance with established guidelines associated with access line workflows.
• Coordinates with medical providers, psychiatrists, drug and alcohol counselors, case managers, and other support staff to ensure continuum of care.
• Oversees the performance of screenings to assist in coordinating behavioral health services.
• Maintains accurate and timely documentation, records, and case files in the Partnership Health Plan of California (Partnership) Case Management System for members in behavioral health access line management system.
• Develops and maintains knowledge of a community-based network of alternative modes of care. Aids member to connect with community-based organizations to support and enhance wellness.
• Conducts and contributes to special training for Partnership staff, professionals, public and private agencies and others as identified.
• Assists with training and relevant educational materials for Behavioral Health Access Guides.
• Handles complex and lengthy calls that cannot be resolved by the Behavioral Health Access Guides or Leads.
• Attends and delivers community presentations and orientations as needed.
• Educates members and providers on the guidelines and policies of Partnership.
• Assesses and resolves problems within scope of authority; escalates unusual questions or problems to higher authority levels.
• Communicates clearly and effectively through all mediums of communication with members, providers, vendors, community partners, and Partnership employees.
• Supports successful transition of care for members discharged from a residential setting transitioning to a lower level of care within the community, to include assessing member needs and identifying appropriate staff to carry out identified needs, effective and frequent communication with providers, members, county partners and identified health care designee.
• Performs other duties as assigned including the assumption of new duties.

Education and…