PRINCIPAL RESPONSIBILITIES:

Under the direction of the Manager of Behavioral Health, the Behavioral Health Supervisor ensures the quality and effectiveness of daily operations of the behavioral health team. The behavioral health team conducts utilization review and case management for the Alliances membership. The incumbent in this role is responsible for the monitoring, developing, implementing, and evaluating activities to align with organizational quality, regulatory and member service goals. Key duties involve utilization management, and case management for members, and educating, coaching, and overseeing staff in utilization management and case management processes. The role conducts regular audits across a multi-disciplinary team analyzing clinical documentation and providing constructive feedback for improvement to the Manager. Additionally, the Supervisor maintains training materials, serves as a subject matter expert, and supports both clinical and non-clinical team members in problem-solving and daily tasks.

Principal responsibilities include:

• Oversee daily operations of behavioral health staff, ensuring alignment with organizational objectives
• Provide clinical guidance and supervision to staff members.
• Supervise daily workload distribution and performance management.
• Provide utilization review and case management services for Alliance members
• Collaborate with other departments to improve organizational processes and member care.
• Serve as liaison between internal and external stakeholders.
• Participate in recruitment, hiring, and staff training.
• Complete performance evaluations annually

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``` - Maintains clinical expertise and knowledge of best practices for all relevant clinical areas of behavioral health including statutory and regulatory requirements. - Work closely with licensed and unlicensed staff to co-manage the care of complex cases telephonically through regular contact with members, caretakers, healthcare professionals and others involved in the members care. - Review screening tools, assessments, and other documentation to triage members referrals from health professionals, clinical facilities, and ancillary providers for mental health services and possible case management. - Be readily available via phone queue for crisis/emergent calls and incoming calls when the primary care manager is unavailable - Conduct mental health screenings per Medi-Cal guidelines as needed. - Provide risk assessments for members who meet criteria based upon Medi-Cal screening tool responses and identify/coordinate referral options in a timely manner. - Reviews activities including progress and barriers towards goals, resolves conflicts or strategizes solutions to support coordination of services/care as needed.

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``` - In conjunction with compliance, reviews and analyzes reports and policies provided by delegated vendors and participates in on-site audits as requested.

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``` - Adheres to administration of behavioral health care services including identification and development of clinical practice guidelines and associated trainings. - Participates in clinical discussions with providers and community agencies to encourage the incorporation of behavioral health care aspects into their services and planning efforts. - Collaborates with the other local agencies focused on special needs, mental health, and substance use, including Regional Center, Alameda County Behavioral Health (ACBH), and Drug Medi-Cal Organized Delivery System to ensure smooth transitions across the continuum of health care. - Provide timely clinical review of Behavioral Health authorization requests using clinical policies and procedures and nationally recognized evidence-based clinical review guidelines. - Gathers pertinent medical information, screens prior authorization requests for the BH Manager/Senior BH Director. - eviews ICD-10, CPT-4 and HCPCS codes for accuracy and existence of coverage. - Refers cases of possible over/under utilization to the BH Manager and Senior BH Director. - Meets productivity and quality of work standards on an ongoing basis. - Assess members health care status, history, risks, and utilization. - Identify members for potential case management and potential quality issues and refer appropriately. - Assist case management staff with coordinating care for members who have difficulty/barriers accessing care. - Provide clinical support and guidance to non-clinical staff. - Communicate, as needed, with the BH Manager, Senior BH Director and the Senior Medical Director to validate patient acuity and plan of care; refer authorization requests for potential denial to the Senior BH Director. - Complete other duties and special projects as assigned. - Identify and address training needs for staff.

ESSENTIAL FUNCTIONS OF THE JOB

• Clinical and administrative supervising, auditing, monitoring, and training of behavioral health staff.
• Completing utilization reivews, and maintain case management cases
• Writing, reporting, administration, and analysis.
• Communicating effectively and efficiently internally and externally.
• Developing long and short-range strategic goals for case management/utilization review activities.
• Making verbal presentations.
• Act as a resource to staff in daily coaching and problem solving.
• Leading and participating in internal and external committees and meetings.
• Complying with the organizations Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS

• Constant and close visual work at desk or computer.
• Constant sitting and working at desk.
• Constant data entry using keyboard and/or mouse.
• Frequent use of telephone headset.
• Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of folders and other objects weighing between 0 and 30 lbs.
• Frequent walking and standing.

Number of Employees Supervised: 6-10

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• Social Worker, Marriage and Family Therapist, Psychologist, Registered Nurse with a license, active and unrestricted in the State of California.
• Masters in nursing, social work, marriage family therapy, psychology required.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• 5 years behavioral health experience.
• 3 years working within the managed care/care management environment required
• 5 years of experience as a lead or supervisory role required.
• 4+ years of experience in nursing, training, or auditing in a healthcare setting required.

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

Knowledge of Medi-Cal and Department of Health Care Services and/or Medicare regulations and standards a plus.

Bilingual Spanish/Vietnamese/Mandari/Cantonese a plus

Knowledge of billing codes and procedures

Ability to motivate, train, and supervise.

Ability to make thoughtful decisions and exercise sound judgment.

Experience with planning, implementing, and evaluating clinical and disease prevention programs a plus.

Background in population-based community health assessment and interventions preferred.

Ability to work effectively in a multidisciplinary approach in management.

Ability to co