United Spinal Association Jobs

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 specialists 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 Alliances 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 and 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 anagers and the Behavioral Health Department for triage and referral for members with urgent or complex needs.

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 Autism.

Ensures MLS BH staff provides appropriate triage and referral of members behavioral and social service needs both within and outside AAH to coordinate members care.

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 identified.

Serves as an advocate to assist in coordinating the members identified psychosocial needs, utilizing community resources and support when appropriate.

Develops and maintains a network of current community resources and services for members.

Maintains documentation of member interactions within the Member Services Management System (HealthSuite/QualitySuite), as needed.

Initiates referrals to both internal care management departments, and other government agencies.

Using critical thinking and problem-solving skills, quickly resolve issues and identify resources to ensure a positive member experience and complete satisfaction.

Educates members about resources, eligibility, and services with a positive and professional approach.

Maintains complete and accurate documentation of contacts within proprietary database

Assists member walk-ins in coordination with medical and behavioral health services care teams.

Meet performance goals established for the position in the areas of efficiency, call quality, member satisfaction, first call resolution, production, compliance, punctuality, and attendance.

Identifies the training needs including assisting in the development of programs, training materials, job aids, orientation checklists, and competency checklists necessary to meet the educational and training needs of departmental staff

Develops tools and workflows to assist in the training and development of staff

Responsible for maintaining any training materials to align with the current process to provide accurate and consistent plan benefit and service information to members to meet regulatory requirements.

Develops and conduct team training and education courses, including management education and training for new employees, ongoing staff, and cross-training of staff as needed.

Develops and maintains complex audit processes and audit tools related to grievances, quality, compliance, and accurate data entry.

Trains staff to use audit tools and identify patterns or trends that require additional training or corrective action.

Educates staff as necessary to ensure consistent performance and adherence to standards.

Audit staff in accordance with established auditing processes, work with the team to identify and resolve errors in data and reporting, and present findings and recommendations for improvement to management.

Coaches and trains staff to identify the potential quality of care/service and accessibility concerns and refer to Grievance and Appeals (GandA) or Quality Improvement (QI).

Identifies opportunities for process improvements to facilitate department functions and ensure compliance with applicable governmental program guidelines.

Provides leadership while serving as a subject matter expert for Member Services and acts as a resource for AAH and community partners.

Identifies system issues that fail to provide appropriate service to members or meet service expectat