• Behavioral Health Operations Specialist II

    LA Care Health Plan (Los Angeles, CA)


    Behavioral Health Operations Specialist II

     

    Job Category: Clinical

     

    Department: Behavioral Health

    Location:

    Los Angeles, CA, US, 90017

     

    Position Type: Full Time

     

    Requisition ID: 12263

     

    Salary Range: $67,186.00 (Min.) - $87,342.00 (Mid.) - $107,498.00 (Max.)

     

    Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

     

    Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

    Job Summary

    The Behavioral Health Operations Specialist II is responsible for supporting, coordinating and facilitating several areas of the Behavioral Health Department. This position assists members with accessing Behavioral Health services and provides guidance and support to members encountering complex needs when navigating the health care system. This position also provides support with collecting and analyzing data from behavioral health vendor, County Department of Mental Health, Public Health and direct Applied Behavioral Analysis (ABA) providers. This position provides support with submitting required reporting elements in a timely fashion to regulatory organizations. Furthermore, the Behavioral Health Operations Specialist also facilitates providers with technical and logistical guidance when coordinating with internal and external stakeholders. This position supports the department with behavioral health related quality improvement, compliance, and regulatory support within the Behavioral Health Treatment Program and Clinical teams.

    Duties

    Day to day vendor and member support including, but not limited to, trainings, education and information to vendors and responding to all vendor related inquiries.

     

    Provides program support for the department to ensure successful development/implementation of existing and emerging initiatives. Coordinate and assist with logistics for assigned tasks/activities, develop written communications, presentations as needed.

     

    Works collaboratively with the ABA and Clinical teams to ensure compliance and smooth business operations.

     

    Analyzes and resolves complex problems dealing with grievances and appeals. Provide policy and procedure interpretation and implement processes. Coordinates and leads regular meetings with vendors, track and analyze metrics, lead solutions and review/audit files, to improve health outcome care measures and provide status reports to management and business partners.

     

    Supports with Healthcare Effectiveness Data and Information Set (HEDIS), National Committee for Quality Assurance (NCQA) and Quality Improvement (QI) reporting, audit preparation and data collection.

     

    Works to support other Behavioral Health Department projects and initiatives.

     

    Performs other duties as assigned.

    Duties Continued

    Education Required

    Associate's Degree

     

    In lieu of degree, equivalent education and/or experience may be considered.

    Education Preferred

    Bachelor's Degree

    Experience

    Required:

    At least 4 years of provider services/relations experience in a healthcare field, including behavioral health related field or medical group.

     

    Experience providing excellent customer service.

     

    Skills

    Required:

    Work proactively in collaborate team environment.

     

    Strong organizational, multi-tasking and time management skills.

     

    Strong written and verbal communication skills.

     

    Ability to lead and present in small and large group settings.

     

    Essential computer skills. Proficient with Microsoft Office, especially Word and Excel.

     

    Ability to be flexible as position evolves with the needs of the department and new developments at the State and Federal level.

     

    Knowledge of file review/auditing.

     

    Licenses/Certifications Required

     

    Licenses/Certifications Preferred

    Required Training

    Physical Requirements

    Light

     

    Additional Information

     

    Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

     
     

    + Paid Time Off (PTO)

    + Tuition Reimbursement

    + Retirement Plans

    + Medical, Dental and Vision

    + Wellness Program

    + Volunteer Time Off (VTO)