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Managed Care Outreach Coordinator
1 month ago
Pacific Clinics is a leading community-based nonprofit provider of behavioral and mental health services and support in California. With a team of over 2,000 employees speaking 22 languages, we are dedicated to offering hope and unlocking the full potential of individuals and families through culturally responsive, trauma-informed, research-based services.
Our MissionWe serve children, transitional age youth, families, adults, and older adults, offering 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.
Job SummaryThis role plays a critical part in engaging potential customers in managed-care and similar programs, such as CCBHC. The successful candidate will be adept in a fast-paced environment with high-volume referrals and will provide administrative support functions and tasks to ensure programs meet customer, referral, payor, and staff support needs.
Responsibilities- Provides administrative support functions and tasks to ensure programs meet customer, referral, payor, and staff support needs.
- Assists with the implementation of internal processes that ensure accountability for various fiscal and administrative operations.
- Reviews TEL List, assigns staff to clients in HHE and HHP, deactivates excluded referrals, communicates deactivated enrollees via approved business processes, and reviews Medi-Cal status and communicates to clinical staff and Billing.
- Serves as liaison for shared services, coordinates with other departments to meet various reporting and compliance needs.
- Manages authorizations with payors, implements 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.
- Assists with program audits, customer contact to support clinical program, and regional QA for CQI activities and compliance.
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.
- 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).
Pacific Clinics is an equal opportunity employer and 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.
