Manager of MCP Benefits

Children's Institute•Los Angeles, CA

About The Position

Manages the planning, organization, and implementation of Managed Care Provider (MCP) benefits including but not limited to Enhanced Care Management (ECM), Community Supports (CS) and Community Health Worker (CHW). DUTIES SUMMARY Manages the planning, organization, and implementation of Managed Care Provider (MCP) benefits including but not limited to Enhanced Care Management (ECM), Community Supports (CS) and Community Health Worker (CHW). ESSENTIAL DUTIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Manages assigned programs to ensure compliance with all agency policies and procedures including adhering to all MCP, local, state and/or federal funding requirements. Manages all aspects of related projects including their implementation, space planning, staff recruitment, service development, community outreach and marketing. Maintains ongoing communication and certification procedures with managed care providers and other contractual partners. Schedules and participates in regular meetings with managed care providers. Seeks opportunities to build relationships with health care providers, local and community organizations, government agencies to support enrolled members and staff. Coordinates ongoing communication with other agency programs and community partners to support internal referrals into MCP benefits. Ensures all staff are provided with individualized orientation plans, training plans, direct field observations and performance evaluations. Leads case conferences and team meetings to monitor individual needs and services plan to ensure effective quality clinical service delivery in alignment with CII’s service philosophy. Ensures that member insurance eligibility and accuracy of the Targeted Engagement List/Member File, and timely tracking of outreach activities is confirmed monthly. Ensures timely, high-quality documentation of services in accordance with CII and contractual requirements including ensuring charts are audit ready at all times. Utilizes the data (program outcomes, enrollment numbers, conversion rates, etc.) to improve program procedures, identify needs, and highlight program successes. Collaborates with other CII departments to ensure program requirements are met. Partners with management team to integrate cross program activities and function. ADDITIONAL DUTIES Other duties and special projects as assigned. SUPERVISORY RESPONSBILITIES Responsible for the overall direction, coordination, and evaluation of the direct reports. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. Position supervises 4-6 staff. QUALIFICATIONS EDUCATION & EXPERIENCE BA/BS Degree in Health Administration, Nursing, Public Health, Social Work, Psychology or related field required; Master's degree in Health Administration, Nursing, Public Health, Social Work, Psychology or related field preferred (substitutes for two years of supervisory experience). 3+ years of managerial, supervisory experience. 5 years of professional level outpatient medical, community health service delivery, behavioral practice management, or related healthcare experience. OTHER QUALIFICATIONS Valid driver's license and state-required auto insurance. May require some travel. Ability to work with minimal supervision. Spanish / English bilingual preferred. Ability to handle confidential information. Maintains patient privacy, including protecting the confidentiality, safeguarding the integrity and availability, and limiting the use and disclosure of patient Protected Health Information (PHI) to authorized individuals and entities. Participates in, conducts, and sustains performance quality improvement activities according to designated role and responsibilities. Sensitivity to service population’s cultural and socioeconomic characteristics. Excellent verbal and written communication skills. CERTIFICATES, LICENSES, REGISTRATIONS Board of Behavior Sciences (BBS) or Board of Psychology (BOP) license preferred. COMPUTER SKILLS Advanced knowledge Microsoft Office 365 (Word, Excel, Teams, etc.) VISION REQUIREMENTS No special vision requirements. NOISE LEVEL Moderate noise REQUIRED TRAINING New Hire Orientation AB1825: Harassment Prevention training Mandated Reporter CPR/First Aid

Requirements

BA/BS Degree in Health Administration, Nursing, Public Health, Social Work, Psychology or related field required
3+ years of managerial, supervisory experience.
5 years of professional level outpatient medical, community health service delivery, behavioral practice management, or related healthcare experience.
Valid driver's license and state-required auto insurance.
May require some travel.
Ability to work with minimal supervision.
Ability to handle confidential information.
Maintains patient privacy, including protecting the confidentiality, safeguarding the integrity and availability, and limiting the use and disclosure of patient Protected Health Information (PHI) to authorized individuals and entities.
Participates in, conducts, and sustains performance quality improvement activities according to designated role and responsibilities.
Sensitivity to service population’s cultural and socioeconomic characteristics.
Excellent verbal and written communication skills.
Advanced knowledge Microsoft Office 365 (Word, Excel, Teams, etc.)
New Hire Orientation
AB1825: Harassment Prevention training
Mandated Reporter
CPR/First Aid
Influenza immunization or declination
COVID-19, MMR and Tdap immunizations
Education verification
Reference check
Background fingerprint clearance (FBI, DOJ, CACI) conducted by the California Department of Social Services
Drug and alcohol screening
Tuberculosis screening

Nice To Haves

Master's degree in Health Administration, Nursing, Public Health, Social Work, Psychology or related field preferred (substitutes for two years of supervisory experience).
Spanish / English bilingual preferred.
Board of Behavior Sciences (BBS) or Board of Psychology (BOP) license preferred.

Responsibilities

Manages assigned programs to ensure compliance with all agency policies and procedures including adhering to all MCP, local, state and/or federal funding requirements.
Manages all aspects of related projects including their implementation, space planning, staff recruitment, service development, community outreach and marketing.
Maintains ongoing communication and certification procedures with managed care providers and other contractual partners.
Schedules and participates in regular meetings with managed care providers.
Seeks opportunities to build relationships with health care providers, local and community organizations, government agencies to support enrolled members and staff.
Coordinates ongoing communication with other agency programs and community partners to support internal referrals into MCP benefits.
Ensures all staff are provided with individualized orientation plans, training plans, direct field observations and performance evaluations.
Leads case conferences and team meetings to monitor individual needs and services plan to ensure effective quality clinical service delivery in alignment with CII’s service philosophy.
Ensures that member insurance eligibility and accuracy of the Targeted Engagement List/Member File, and timely tracking of outreach activities is confirmed monthly.
Ensures timely, high-quality documentation of services in accordance with CII and contractual requirements including ensuring charts are audit ready at all times.
Utilizes the data (program outcomes, enrollment numbers, conversion rates, etc.) to improve program procedures, identify needs, and highlight program successes.
Collaborates with other CII departments to ensure program requirements are met.
Partners with management team to integrate cross program activities and function.
Responsible for the overall direction, coordination, and evaluation of the direct reports.
Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws.
Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Benefits

Generous paid PTO, plus 10 paid holidays and CII is closed between Christmas and New Year
Excellent medical, dental, and vision insurance for eligible employees and qualified dependents
403b Retirement Plan with employer contribution for eligible employees
Up to $4,500 in tuition reimbursement per calendar year
Eligible for the Public Service Loan Forgiveness program
Flexible Spending Account (FSA) & Health Savings Account (HSA)
Employer paid Life and AD&D Insurance
Voluntary Supplemental Insurance
Opportunity for growth & advancement
Professional development & continued training
Team building & bonding through company sponsored events & activities