Managed Care Outreach Specialist

Pacific Clinics•San Jose, CA

17h•Hybrid

About The Position

Pacific Clinics' School-Based Intervention Teams (SBIT) provide tiered behavioral health services across various locations (e.g., school sites, community, and via telehealth). SBIT services are delivered within a Multi-Tiered Systems of Support (MTSS), with a focus on Positive Behavioral Intervention Supports (PBIS), Wellness Center implementation, Social Emotional Learning, Restorative Practices, various evidence-based practices to support Community School efforts. Reports to the CPM or Program Administrator and support them in administration functions of the program. This position plays a critical role engaging potential customers in managed-care and similar programs (e.g., CCBHC).

Requirements

High School Diploma or GED and two (2) years of related experience, or equivalent combination of education and experience (two years of relevant experience equals one year of education) to include:
Six (6) months of experience in an administrative position in the Mental Health field.
One (1) year experience in an administrative position in the Mental Health field where data management and visualization tasks were involved.
Must pass Department of Justice (DOJ), Federal Bureau of Investigations (FBI), and Child Abuse Index Check (CAIC) background clearance.

Nice To Haves

Intermediate to advanced excel
Highly organized and detailed oriented
Flexible & adaptable
Analytical-ability to analyze detail to inform actions

Responsibilities

Provides administrative support functions and tasks to ensure programs meet the customer, referral, payor, and staff support needs required to meet agency and contract expectations.
Assists with the implementation of internal process that ensures the accountability for various fiscal and administrative operations.
Review TEL List.
Assign staff to clients in HHE and HHP.
Deactive excluded referrals.
Communicate deactivated enrollees via approved business processes.
On-going review of medi-cal status and communicate to clinical staff and Billing.
Serves as liaison for shared services; coordinates with other departments to meet various reporting and compliance needs.
Manage authorizations (i.e., initial, renewal) with payors; implement processes with program managers and client services to prevent lapse of authorizations.
Consults with finance department and program managers/directors about claims and billing issues and concerns.
Assists with program audits, and customer contact to support clinical program (e.g., intake, discharge).
Support regional QA for CQI activities and compliance.
Practice self-care, remain aware that others may be contending with stress, and treat other with grace.
Performs other responsibilities, as assigned, to support specific department/business needs.