Gold Coast Health Plan will not sponsor applicants for work visas.
The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California.
POSITION SUMMARY
The Gold Coast Health Plan (GCHP) Behavioral Health Program Specialist supports the GCHP mission to improve the health of the members through development and oversight of the best possible quality care and services.
The Behavioral Health Program Specialist works independently under the direction of the Manager of Behavioral Health to support the development and administration of key clinical initiatives that support Gold Coast Health Plan’s strategic vision, including the development of whole person care approaches, addressing social determinants of health, and behavioral health integration.
In this role, the Behavioral Health Program Specialist works closely with community organizations, partners, and providers, as well as other team members and is a role model and resource to colleagues. This position is differentiated from other specialist positions in the organization by the focus on behavioral health and social programs such as the Student Behavioral Health Incentive Program (SBHIP). This position will be responsible for supporting delivery of new benefits, managing and developing oversight strategies for programs and services delivered through delegates and vendors, as well as developing and implementing methods to track, monitor, and manage programs, services, and benefits.
Work Schedule: Travel required 5-10%; work protracted and irregular hours and evening meetings, or work unusual hours for meeting attendance or participation in specific projects or programs.
ESSENTIAL FUNCTIONS
Reasonable Accommodations Statement
To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.
Essential Functions Statements
• Research and synthesize key points to facilitate understanding and action for new lines of service or incentive programs.
• Utilize knowledge of program development and evaluation to provide management and oversight of behavioral health and social programs and their providers.
• Coordination data collection/reporting and prepare program reports and documents timely (e.g. reports to the California Department of Health Care Services)
• Facilitate, convene, and engage stakeholders in collaborative program development.
• Assist with new behavioral health benefit implementation.
• Evaluate for service delivery and program gaps and develop improvement recommendations.
• Work collaboratively with departments such as quality and population health to generate data insights for program development, management, improvement, and evaluation
• Assist in the development of integrated strategies to increase the delivery of coordinated, high-quality services and access to care.
• Draft/revise Policies and Procedures
• Provide technical assistance to partners and vendors for required reporting to Department of Health Care Services
• Monitor performance of incentive programs and audit new benefits to ensure quality and access.
• Provide planning and reporting support for Carelon and Ventura County Behavioral Health (VCBH), including Joint Operating Meetings, and mandates such as No Wrong Door.
• Coordinate Performance Improvement Projects with Information Technology, Quality, delegates, and providers to ensure achieving targets for Medi-Cal Managed Care Accountability Set (MCAS) quality measures and National Council for Quality Assurance (NCQA) accreditation.
• Ensure confidentiality of protected health information and maintain compliance with privacy laws.
• Assist with data collection as required.
• Prepare written reports, supporting and reporting required metrics, and other pertinent performance data, as directed.
• Provide accurate documentation to meet departmental policies, regulatory requirements, and audits.
• Attend meetings and conferences at local and state levels and make both written and oral presentations as necessary.
• Adhere to all GCHP Policies and Procedures and meet required performance standards.
• Establish and maintain effective working relationships with internal and external providers, partners, community resources and service agencies.
• Other duties as assigned by manager/director.
• Perform clinical audits to ensure compliance with requirements.
• Ability to engage easily in abstract thought.
• Strong organizational, delegation and task prioritization skills.
• Member advocacy focus.
• Knowledge of required regulatory timelines to ensure department compliance with State contracts.
• Ability to convey empathy and is nonjudgmental of the member.
• Ability to stay calm and professional when working with internal and external partners.
• Ability to multi-task, both with and without supervision, with attention to detail.
• Exhibit accountability by maintaining good attendance.
POSITION QUALIFICATIONS
• Expertise in behavioral health service delivery and program development/evaluation.
• Ability to work collaboratively with internal departments to develop policies reflective of operational needs and in compliance with state and federal regulations, and contractual requirements.
• Strong organizational, analytical, problem solving, and project management skills.
• Demonstrated ability to build strong relationships with external partners.
• Ability to adapt to constantly changing priorities in managing various projects simultaneously.
• Maintain a high degree of credibility, confidentiality, and integrity.
• Work independently on assigned projects.
• Work as a team member as department tasks dictate.
• Prioritize tasks according to internal and external deadlines.
• Ability to communicate research findings clearly through tables, charts, and figures.
Competency Statements
• Management Skills - Ability to organize and direct oneself and effectively supervise others.
• Business Acumen - Ability to grasp and understand business concepts and issues.
• Customer Oriented - Ability to take care of the customers’ needs while following company procedures.
• Coaching and Development - Ability to provide guidance and feedback to help others strengthen specific knowledge/skill areas.
• Communication, Oral - Ability to communicate effectively with others using the spoken word.
• Team Builder - Ability to convince a group of people to work toward a goal.
• Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.
SKILLS & ABILITIES
Education: Training and education or attainment of a degree in public health, healthcare administration, or related fields.
Experience:
• 2 or more years of experience in the health care field desired, especially program development and evaluation, health administration or equivalent combination of education and experience.
• Managed care experience in a health plan preferred.
Computer Skills:
• Strong background and knowledge of computer systems.
• Personal computer skills included in the MS Office products.
• Data collection, analytics, and reporting.
Other Requirements:
Desired:
• An attitude to excel, a special empathy for working with multiple populations, an investigative personality and a willingness to mentor colleagues.
• A working knowledge of Medi-Cal and related policy and regulations.
Required:
• Ability to evaluate clinical and other health data and to communicate effectively both orally and in writing.
• Ability to synthesize thoughts and plans succinctly in writing. Ability to balance multiple tasks.
• Strong organizational skills. Critical thinking skills.
• Flexibility in role delineation and workload assignments. Team player.
