Member Services Supervisor Behavioral Health/job
6 days ago
**PRINCIPAL RESPONSIBILITIES**:
Under general direction from the Sr. Manager, Member Services, the Member Services Supervisor, Behavioral Health (BH), is responsible for the day-to-day supervision of Member Liaison Specialists (MLS), collaborating with other department Supervisors and other department leadership members to meet and exceed performance targets. The Member Services Supervisor (BH) requires a comprehensive understanding of mental health disorders to determine the appropriate level of care for members and interface with the Behavioral Health Team regarding appropriate BH and ASD member triage and referrals.
The Member Service Supervisor (BH) is responsible for ensuring member concerns are processed in a timely and accurate manner by communicating and enforcing department goals and objectives within a total quality management approach and compliance with all applicable state and federal regulations.
The Member Services Supervisor (BH) will be responsible for the quality of the member liaison specialist’s daily work and activities, including but not limited to monitoring, developing, implementing, and evaluating the departmental call center operations to ensure optimal proficiency and effectiveness. The Supervisor will oversee assigned production and workflow systems, monitor, and enforce production and quality standards, ensure compliance with all operating policies and procedures, and collaborate with other departments to ensure the Alliance’s business, operating, and reporting goals are met. The Supervisor may occasionally function as a Member Liaison Specialist (BH) in high call volumes or staffing shortages.
**PRINCIPAL RESPONSIBILITIES INCLUDE**:
- Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity, and accountability.
- Assists the team in carrying out department responsibilities and collaborates with others to support short and long-term goals/priorities for the department.
- Oversees the process, management and reporting of the team's activities.
- Assists escalated callers as needed.
- Works with MS leadership to develop, implement and refine regular reporting metrics to measure productivity and process outcomes.
- Implements process improvements as identified and approved by MS leadership.
- Works cross functionally to review and revise policies and procedures to ensure National Committee for Quality Assurance (NCQA), Department of Managed Health Care (DMHC), Centers for Medicare & Medicaid Services (CMS) and Department Health Care Services (DHCS) regulatory compliance.
- Assists with developing, documenting, and updating regulatory and departmental compliance desktop/SOP policies and procedures.
- Builds, maintains and enhances relationships with the County of Alameda Behavioral Health (ACCESS), providers, health networks, community-based organizations and other key stakeholders.
- Maintains knowledge of current regulatory requirements and industry trends.
- Demonstrated knowledge of Medi-Cal benefits, Department of Health Care Services (DHCS) and Department of Managed Health Care (DMHC) regulations.
- Knowledge of local health care community including medical, housing, behavioral health, and social services.
- Superior communication skills and ability to effectively facilitate meetings and deliver information/presentations.
- Strong organizational skills: able to adapt to changing environment, work independently, and manage multi-task responsibilities.
- Ability to work with a high level of independence with strong collaboration and relationship management skills.
- Strong analytical and problem-solving abilities.
Supervises the daily operations of BH Member Services Call Center staff to ensure appropriate usage of resources to facilitate the Call Center process.
- Follows Behavioral Health guidelines and protocols in coordinating with Behavioral Health Care Managers and the Behavioral Health Department for triage and referral for members with urgent or complex
- Ensures MLS BH staff provides a smooth and compassionate customer service experience for members or members’ authorized representative(s).
- Ensures MLS BH staff provides ongoing customer service support for members receiving ABA services for
- Ensures MLS BH staff provides appropriate triage and referral of members’ behavioral and social service needs both within and outside AAH to coordinate members’
- Collaborates and communicates with the members, conservators, authorized member representative(s), provider office staff, health networks, and other health care providers to support and accomplish goals
- Serves as an advocate to assist in coordinating the members’ identified psychosocial needs, utilizing community resources and support when
- Develops and maintains a network of current community resources and services for
- Maintains documentation of member interactions within the Member Services Management System (HealthSuite/Q
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