Under general direction, to plan, administer, manage, evaluate, and oversee a Behavioral Health Managed Care Division and supervise the staff assigned to that division.
Currently, there is one Behavioral Health Managed Care Division Director opening:Under administrative direction of the Behavioral Health Services Department (BHSD) Quality Director and clinical direction from the Quality and Utilization Management Medical Director (QUMMD), this position maintains accountability for utilization management (UM) functions to achieve the business and clinical outcomes, meeting contract requirements, and supporting initiatives with providers and members to manage behavioral health care benefits. The functions overseen by the Director include UM and criteria-based reviews of care, appropriate placements and discharges, clinical appeals regarding medical necessity, and the interaction with claims payment policies and processes. The UM Director will provide direction to the UM Clinical and Non-Clinical Staff, ensuring that the appropriate level of member care is being provided. In collaboration with the Managed Care Leadership, assists in coordinating UM functions and programs which effectuate and support the department policy according to contractual requirements, and in developing and implementing new clinical programs to ensure quality care delivery.
The County of Santa Clara Behavioral Health Services Department (BHSD) strives to be a premier integrated behavioral health care provider, employer, and partner. We are a passionate team of caring, courageous staff and professionals dedicated to transforming the lives of individuals, children, families, and older adults impacted by mental health and substance use challenges. To support achievement of their hopes, dreams, and quality of life goals, our team provides high quality whole-person care and comprehensive community-based behavioral services through the lens of race, equity, diversity and inclusion. We are looking for stellar health care professionals like you to fulfill a rewarding career with us and be a partner for health and wellness in the community.
The following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Each individual in the classification does not necessarily perform all duties listed.
- Oversees and manages a behavioral health plan (mental health and/or DMC-ODS);
- Oversees managers and staff in the planning, organizing, managing, implementing, evaluating, and coordinating of managed care operations;
- Directs, coordinates, and evaluates efficiency and productivity of managed care functions for behavioral health services;
- Develops, achieves, and maintains benchmarked goals and quality improvement objectives;
- Ensures compliance with standards as outlined in contracts for managed care functions;
- Writes and prepares program proposals, grants, and reports;
- Oversees the development and administration of the assigned division's budget;
- Supervises, directs, trains, and evaluates subordinate staff;
- Attends and participates in internal and external committee meetings, planning councils, community boards, and coalitions;
- Represents the division, as assigned, at cross-departmental meetings and interagency collaborative service efforts;
- Acts as a liaison and represents the Department in relationships with service providers, county departments, state and other funding sources, and community and business organizations;
- May be assigned as a Disaster Service Worker (DSW), as required;
- Performs other related duties, as required.
Sufficient education, training, and experience to demonstrate the ability to perform the above tasks, plus the possession and direct application of the following knowledge and abilities:
Training and Experience Note: The required knowledge and abilities are attained through training and experience equivalent to a Bachelor’s Degree, preferably in Social Work, Psychology, Behavioral Health, Mental Health, Substance Use Disorders, Nursing, Health Care Administration, or a related field. Relevant analytical, administrative, lead, supervisory, or management experience that includes interpreting rules and regulations, gathering data and formulating recommendations, and report writing can substitute for education on a year-for-year basis;
And
Seven (7) years of analytical, administrative, lead, supervisory, and/or management experience in a Behavioral Health and/or managed care system, including three (3) years in utilization review, quality management, and/or case/care management.
Possession of a Master’s Degree in Social Work, Psychology, Behavioral Health, Mental Health, Substance Use Disorders, Nursing, Health Care Administration, or a related field may substitute for two (2) years of the required analytical, administrative, lead, supervisory, and/or management experience in a Behavioral Health and/or managed care system.
Special Requirements- For clinical areas, possession of a license as a Licensed Clinical Social Worker, Licensed Marriage & Family Therapist, or Licensed Psychologist, issued by the California Board of Behavioral Sciences, or a license as a Registered Nurse, issued by the California Board of Registered Nursing, prior to appointment and maintenance of the license for the duration of employment in this classification.
- Ability to travel to alternate locations in the course of work. If driving, possession of a valid California driver’s license prior to appointment and the ability to qualify for and maintain a County driver authorization.
- *As a condition of employment, pursuant to California Government Code Sections 3100- 3109 and Local Ordinance, all County of Santa Clara employees are designated Disaster Service Workers (DSWs), including extra help. A DSW is required to complete all assigned DSW-related training, and in the event of an emergency, return to work as ordered.
Knowledge of:- Principles and practices of behavioral health, mental health, and substance use disorders, diagnosis, and treatment;
- Principles and practices of utilization management and care coordination in behavioral health or managed care settings;
- Principles and practices of supervision, staff development, organization, administration, and management;
- Principles, practices, and techniques of program development, implementation, and evaluation in a behavioral health setting;
- Principles and techniques of budgetary analysis, preparation, and control;
- Information systems, data management, and utilization of electronic health records;
- Public sector contract development, negotiations, and administration, including evaluation methods to ensure contract compliance;
- Grant preparation;
- Strategic planning and systems analysis in behavioral health program administration;
- English usage, style, grammar, punctuation, and spelling;
- Common computer systems and applications;
Ability to:- Plan, organize, implement, evaluate, and manage comprehensive behavioral health managed care for a specific functional division;
- Create clear and concise verbal and written reports;
- Understand and interpret the laws, rules, and regulations applicable to community behavioral health programs and the detailed provisions of contractual agreements;
- Identify and analyze the need for program, practice, and policy changes and facilitate their development and implementation;
- Develop and administer a large, complex program budget;
- Understand and integrate cultural values and practices of the diverse communities served by the department into programs and services;
- Evaluate professional competence of subordinate program staff members;
- Read and understand material safety data sheets and other safety communications;
- Communicate effectively, both orally and in writing, with people of diverse backgrounds and cultures;
- Establish and maintain effective working relationships with those contacted in the course of work, at all levels, including colleagues, the public, and representatives of other agencies.
#J-18808-Ljbffr
