Director of Managed Care Operations

Job Description

Job Description

Description:

The CalMHSA Way:

• Curiosity
• Innovation
• Grounded in Mission
• Ownership
• Clarity

SUMMARY:

Under the supervision of the Senior Director of Quality Assurance and Compliance, this position performs clinical and administrative functions that support counties in quality improvement and utilization management. In addition, this position partners with county and contractor staff by providing training, technical assistance, and guidance to support best practices in clinical documentation, program effectiveness, continuous quality improvement, and the processes and outcomes of care.

The ideal candidate for this position will have a strong knowledge of and proven experience working with behavioral health, regulatory requirements and data analysis. He/she will be highly organized, dependable, and detail-oriented with the ability to plan, delegate and complete assignments with a high degree of accuracy. The ideal candidate will have the ability to cultivate strong, collaborative relationships with county partners and serve as a trusted advisor by providing consultation, guidance, and expertise on best practices. The ideal candidate must have above average competency in working with computers, excellent written and verbal communication skills, and exceptional judgment and decision-making abilities.

Candidates with experience in the public sector environment are highly encouraged to apply.

DUTIES AND RESPONSIBILITIES include but are not limited to:

• Lead in developing quality assurance and improvement activities.
• Support the development of regional compliance practices to regulatory requirements impacting counties.
• Lead strategic planning and implement strategies in collaboration with management team, and other key staff members.
• Perform program development and coordination work to implement and maintain a quality management program that effectively measures, assesses, and continuous improvement in the access to and quality of care/services provided to the County's mental health consumers.
• Develop and lead training initiatives, including activities as a Subject Matter Expert (SME) in areas of quality assurance, policy, and compliance that comply with local, state, and federal regulations.
• Apply and incorporate clinical best practices to training and county behavioral health support.
• Develop and present project related documents which could include reports, contracts, agreements, presentations, and other similar materials.
• Oversee and manage key contracting deliverables and key performance indicators.
• Work closely with regulatory agencies that inform county behavioral health contractual agreements.

BACKGROUND CHECK ELIGIBLE DUTIES
This position requires a background check due to access to confidential information and systems. The Director of Managed Care Operations will have access to various applications housing sensitive data, including county records, employee demographic information, and private behavioral health information. The incumbent must ensure that all access is used responsibly, maintaining the integrity and security of systems while preventing accidental or malicious misuse of confidential information.

QUALIFICATIONS -

EDUCATION and/or EXPERIENCE

• Master's degree with a clinical emphasis
• At least 5 years of management experience
• Experience leading quality improvement initiatives and developing a quality assurance program.

To perform this job successfully, an individual must be able to perform each essential functions satisfactorily. The requirements listed below are representative of the experience, knowledge, skill, and/or ability required.

• Ability to establish and meet deadlines; beginner to intermediate project management skills for managing deadlines with small to medium teams.
• Ability to organize multiple streams of work effectively and multitask; attention to detail and accuracy is required.
• Effective written and oral communications; including an ability to synthesize information from a variety of sources.
• Demonstrated sense of urgency, initiative, responsiveness; proactive approach to work.
• Must have strong verbal and written interpersonal and communication skills.
• The ability to work well with a multidisciplinary team to develop solutions to support CalMHSA's members.
• Highly analytical approach to problem analysis and problem-solving with strong attention to detail and accuracy.
• The ability to read and understand regulatory language.
• Able to multi-task on several projects and collaborate with groups and partners of various technical skill levels.
• Able to prioritize projects and direct available resources as necessary while meeting timelines and remaining within budget.
• Demonstrated ability to remain current with all new regulatory standards around health information technology.
• Knowledge of project management principles.
• Other duties as assigned.

COMPUTER SKILLS – Demonstrate the ability to use a computer and applicable computer software effectively. Intermediate knowledge of Excel & Word, PowerPoint, Adobe, and Outlook.

LANGUAGE SKILLS and MATHEMATICAL SKILLS - Demonstrate the ability to read, comprehend, and respond appropriately through written or verbal form; demonstrate tactfulness when communicating including internal communication with staff members of all levels; ability to communicate with a variety of audiences effectively. Ability to add, subtract, multiply, and divide in all measure units, using whole numbers, common fractions, and decimals.

REASONING – Demonstrate the ability to effectively apply common sense and follow through to daily tasks; demonstrate the ability to work with little or no supervision; demonstrate excellent analytical skills; demonstrate the ability to efficiently conduct research and ask appropriate probing questions to complete necessary tasks.

PHYSICAL DEMANDS - The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is frequently required to sit and stand; use phone and headset; use hands, arms, finders to type; answer phones; write; use calculator; demonstrate strength to lift and carry materials weighing up to 10 pounds; demonstrate clear vision to read printed materials and a computer screen; hearing and speech to communicate in person and over the telephone. Candidate must be able to sit for long periods of time to perform duties, move around, make inquiries from other staff, and management as needed. Must be able to bend or stoop down to access files, including lifting of items or objects up to 20 lbs.

SENSORY DEMANDS - The incumbent must spend long hours in intense concentration. The incumbent must also spend long hours on the computer entering information which requires attention to detail and high levels of accuracy.

MENTAL DEMANDS - There are a number of deadlines associated with this position, which may cause significant pressure. The incumbent must also deal with a wide variety of people on various issues.

REGULAR WORK SCHEDULE – Schedule varies depending on business needs; however, company normal business hours are 8:00am to 5:00pm, Monday – Friday.