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    Managed Care Outreach Specialist - San Francisco, United States - Pacific Clinics

    Pacific Clinics
    Pacific Clinics San Francisco, United States

    2 weeks ago

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    Description
    Who We Are

    Pacific Clinics is California's largest community-based nonprofit provider of behavioral and mental health services and support. Our team of more than 2,000 employees speak 22 languages and are dedicated to offering hope and unlocking the full potential of individuals and families through culturally responsive, trauma-informed, research-based services for individuals and families from birth to older adults.

    Who We Serve

    Pacific Clinics serves children, transitional age youth, families, adults, and older adults. We offer a full range of mental and behavioral health services, foster care and social services, housing, continuing adult education and early childhood education programs to Medi-Cal eligible individuals and families throughout Alameda, Contra Costa, Fresno, Kings, Los Angeles, Madera, Orange, Placer, Riverside, Sacramento, San Bernardino, San Francisco, Santa Clara, Solano, Stanislaus, Stockton, Tulare and Ventura Counties.

    What We Offer
    • Pay Range: Bay Region- $ $30.57 Fresno Region- $ $25.30 Central CA Region $ $27.67 LA Region- $ $27.00 San Bernadino Region LA Region $20.21-$21.83. Compensation may vary based on skills, experience, education, and location.
    • We Offer Medical, Dental & Vision benefits, retirement options, Flex Spending, EAP, and more
    • Employee engagement and advocacy opportunities to advance our justice, equity, diversity, and inclusion agenda across our Agency and throughout the communities we serve.
    JOB SUMMARY

    Works within the vision, mission, and philosophy of the agency. Report 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). Must be adept in a fast-paced environment with high-volume referrals.

    RESPONSIBILITIES AND DUTIES

    Administrative
    • 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.
    Shared Services Coordination
    • Serves as liaison for shared services; coordinates with other departments to meet various reporting and compliance needs.
    Finance/Billing (UM)
    • 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.
    Quality Assurance
    • Assists with program audits, and customer contact to support clinical program (e.g., intake, discharge).
    • Support regional QA for CQI activities and compliance.
    OTHER DUTIES AND RESPONSIBILITIES
    • 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.
    JOB SPECIFIC COMPETENCIES
    • Contributes to Team Performance
    • Manages Multiple Priorities Focus
    • Business Acumen
    • Intermediate to advanced excel.
    • Highly organized and detailed oriented
    • Flexible & adaptable
    • Analytical ability to analyze detail to inform actions.
    QUALIFICATIONS

    To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential job functions. All employees are responsible for keeping job requirements up to date. This can include but are not limited to certifications, licensure, and maintaining a clear criminal record.

    MINIMUM EDUCATION AND/OR EXPERIENCE
    • High School Diploma or equivalent degree in a related field or equivalent work experience required.
    • Six (6) months of experience in an administrative position or Mental Health field required.
    • One (1) year experience in an administrative position or Mental Health field preferred.
    • Experience in fast-paced environment with rapid changes.
    • Data management and visualization experience (preferred).
    Equal Opportunity Employer

    We will consider for employment qualified Applicants with Criminal Histories in a manner consistent with ordinance Sec a) and San Francisco Police Code, Article 49. Section 4905.
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