Community Based Program Specialist

Santa Clara Family Health Plan•San Jose, CA

98d•Onsite

About The Position

The Community Based Program Specialist serves as the lead, primary contact, and liaison for developing, supporting and monitoring the network of public and community-based providers and vendors delivering Enhanced Care Management (ECM), Community Supports (CS), and Community Health Worker (CHW), and/or other activities, programs or special projects addressing social determinants of health.

Requirements

Bachelor’s degree in public health, social welfare or related field; or equivalent experience, training, or coursework.
Minimum two years of progressively responsible and direct work experience working with the essential duties and responsibilities described above.
Demonstrated experience leading/managing projects, initiatives, and/or leading or directing the work of others.
Knowledgeable in the field of home and community-based services and community resource networks and particularly interest in working to address health disparities and addressing the needs of low-income communities.
A deep understanding of SDOH that impact Santa Clara County and community members.
Ability to think creatively and work strategically, to help develop and implement innovative solutions yielding measurable results to the organization.
Ability to think creatively and strategically, gather and analyze data, organize and write reports, organize work efficiently.
Ability to understand, interpret, and apply applicable rules and regulations, and establish and evaluate priorities.
Advanced working knowledge and proficiency with Microsoft Suite applications, and the ability to operate all applicable software.
Excellent oral and written communication skills, including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments and outside entities over the telephone, in person or in writing.
Ability to effectively facilitate meetings and deliver information/presentations to management, regulators, or staff.
Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes.
Ability to take initiative and exercise good judgment when making decisions within the scope of the position.
Ability to comply with all SCFHP policies and procedures.
Ability to perform the job safely with respect to others, to property, and to individual safety.
Maintenance of a valid California driver’s license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events.
Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word and Excel.

Nice To Haves

Knowledge of the community-based delivery system and managed care.
Project Management Professional (PMP) certification

Responsibilities

Develop and maintain updated knowledge of community-based services, and capacity across Santa Clara County and support identification and assessment of ECM, CS, and/or CHW provider network gaps.
Identify initial and ongoing needs to support ECM, CS, and/or CHW, network delivery system, and operational infrastructure including data exchange, workforce training and capacity building.
Support ECM, CS and/or CHW delivery process in accordance with DHCS service definitions, eligibility criteria, and reporting requirements.
Oversee the development and management of the ECM, CS, and/or CHW provider network including serving as a knowledge and resource expert for ECM, CS and/or CHW provider network operations.
Establish and manage positive and productive working relationships with all public and community-based providers and vendors delivering services to members under ECM, CS, and/or CHW.
Receive, research and respond to inquiries and issues that are raised by or impacting providers in a timely fashion and in collaboration with appropriate business units.
Proactively communicate and collaborate with providers to identify problem patterns, track and trend issues, prepare recommendations for potential service improvement opportunities and develop tools and processes to improve communication and other processes.
Oversee collaboration with internal business units, particularly Provider Network Operations, Health Services Department, Finance and Claims, regarding provider communication, training and support and to ensure payments are made in accordance with vendor agreement terms.
Schedule, conduct and report on regular site visits with each provider as required.
Conduct orientation and ongoing training and education to community service providers and office staff including technical assistance, development of presentations and other written guidance or materials, in-person sessions, webinars and/or calls as needed.
Establish and track ECM, CS, and/or CHW provider compliance with agreement scope of work, key operational objectives, and quality and performance metrics.
Support the Department Manager in generating reports and performing special projects.
Troubleshoot with providers to address issues related to submission of claims and encounter data for CHW services.
Understand and track applicable regulatory and reporting requirements.
Ensure accuracy and regulatory compliance for all materials or documents.
Attend off-site meetings or events as necessary.
Perform other related duties as required or assigned.