Clinical Program Manager, Managed Care

Program Description: Pacific Clinics is expanding its service offering to include Non-Specialty Mental Health - outpatient mental health services for individuals of all ages with mild to moderate mental health needs.

Who We Are 

Pacific Clinics is California's largest community-based nonprofit provider of behavioral and mental health services and support. Our team of more than 2,000 employees speaks 22 languages. They are dedicated to offering hope and unlocking the full potential of individuals and families through culturally responsive, trauma-informed, research-based services for individuals and families from birth to older adults. 

Who We Serve 

Pacific Clinics serves children, transitional-age youth, families, adults, and older adults. We offer 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.   

Compensation We Offer

•  The initial compensation for this position ranges from $98,456.02 -$121,088.49 per year.
•  Salary is dependent on commensurate experience above the minimum qualifications for the role and internal equity considerations.
•  The salary may also vary if you reside in a different location than the location posted. 
•  8% License Differential for LMFT, LCSW, LPCC, PsyD. and select Peer Certifications.
• 7.5% Bilingual Differential for qualified positions

Benefits We Offer

•  Benefits eligibility starts on day ONE! 
•  We Offer Comprehensive Medical, Dental & Vision benefits, Voluntary Life Insurance, Flex Spending, Health Savings Account, EAP, and more!   
•  Employer Paid Long-Term Disability & Basic Life Insurance
•  401K Employer Match up to 4%
•  Competitive Time Off Plans (may vary by employment status)
•  Employee engagement and advocacy opportunities to advance our justice, equity, diversity, and inclusion agenda across our Agency and throughout the communities we serve.

JOB SUMMARY

Works within the vision, mission, and philosophy of the agency. Hires, develops, trains, manages, and retains clinical program staff and a clinical team(s) to ensure customer satisfaction and culturally competent service delivery. Functions as the liaison between team, payers, and community partners. Provides fiscal stewardship of team, acts as a bridge between fiscal and other departments. Ensures provision of high quality service by program staff.

RESPONSIBILITIES AND DUTIES

Clinical Care Management

1. Ensures effective quality clinical services delivery for assigned healthplan members.
2. Develops, interprets and ensures consistent implementation of clinical program philosophy, objectives, standards, policies, procedures and practices.
3. Analyzes and integrates the use of outcome data to improve clinical service delivery within assigned team.
4. Ensures and monitors satisfaction and defined outcome achievement for health plan members.
5. Provides effective crisis and risk prevention and management.
6. Provides 24/7 availability as needed. Culturally responsive to internal and external customers, and ensures family voice.
7. Provides direct services to health plan members, as support to the direct service staff, to ensure smooth delivery of service.
8. Responsible for managing referrals (e.g., electronic, telephonic, manual) and assigning accordingly

Program & Fiscal Management

1. Manages day-to-day operations including utilization of all administrative electronic systems, human, and other resources.
2. Ensures staff engage health plan members for enrollment and other revenue related activities meet or exceed revenue forecasts to ensure viable programming.
3. Ensures compliance with all policy and procedures including adherence to all licensing, quality, Information Technology (IT), Human Resources (HR), compliance and regulatory standards.
4. Ensures clinical documentation and