Clinician Sr (Behavioral Health)(Clinical/Care Management)

We are a mission-driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person.

About the role

Join our Behavioral Health Integration team as a Clinician Sr (Behavioral Health) in Clinical/Care Management. This position is responsible for providing care management services for CalOptima Health's members, facilitating communication and coordination among healthcare team participants to promote quality, cost-effective outcomes. You will provide case management intervention for members with behavioral health conditions and may have co-occurring medical needs, along with behavioral health clinical expertise.

This role includes providing back-up to the call center for complex and general calls, completing telephonic behavioral health screenings, determining member behavioral health level of care needs, and coordinating care between physical and behavioral health. You will also coordinate activities between staff, contracted providers, and health networks for CalOptima Health Medi-Cal, OneCare, or Covered CA members.

This position has been approved for Full Telework, requiring work within the State of California only. If Partial Telework is approved, you must come into the main office in Orange, CA, at least two days per week.

Responsibilities

• Participate in a mission-driven culture focused on high-quality performance, customer service, consistency, dignity, and accountability.
• Assist the team in carrying out department responsibilities and collaborate with others to support short- and long-term goals.
• Review and evaluate proposed services using established policies and procedures.
• Analyze requests to monitor utilization of services, ensuring medical appropriateness and identifying high-cost complex cases for intervention.
• Conduct thorough assessments of members' status for short-term cases, including psychosocial and environmental factors.
• Develop and implement member-specific care plans, documenting patient care and progress.
• Evaluate members' progress, schedule follow-ups, and proactively adjust care plans or referrals as needed.
• Establish communication and collaboration methods with team members, physicians, community agencies, and administrators.
• Act as an advocate for clients' best interests regarding funding, treatment alternatives, timelines, and care coordination.
• Collaborate with staff from various disciplines to interpret and problem-solve complex cases.
• Document case notes and rationale for all decisions.
• Coordinate and collaborate between behavioral health providers, health networks, IPAs, and CalOptima Health departments for problem resolution and service integration.
• Build and maintain relationships with the County Behavioral Health Plan, providers, health networks, IPAs, community-based organizations, and key stakeholders.
• Provide subject matter expertise, serve as a resource, and guide CalOptima Health staff.
• Support CalOptima Health Behavioral Health Call Center operations, including telephonic screenings, triage, and complex care coordination.
• Coordinate referrals to the County Behavioral Health Plan for members needing additional mental health or behavioral health support.
• Participate in bi-weekly clinical team meetings.
• Assist members in navigating behavioral health systems of care.
• Support training for new Behavioral Health Clinicians.
• Support the implementation of department and agency initiatives to enhance member care.
• Complete other projects and duties as assigned.

Requirements

• Master’s degree in social work, clinical psychology, marriage and family therapy, or a related field plus 3 years of behavioral health clinical experience; an equivalent combination of education and experience may also qualify.
• Current unrestricted California license as a Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Psychologist (PhD, PsyD).

Preferred Qualifications

• 2 years of behavioral health case management experience.
• 1 year of call center experience.
• Bilingual in English and one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese).

Skills

• Develop rapport and maintain effective working relationships with leadership, staff, and external contacts.
• Work independently and exercise sound judgment.
• Communicate clearly and concisely, both orally and in writing.
• Work a flexible schedule, including evenings and weekends as needed.
• Organize, analyze, problem-solve, and manage projects effectively.
• Work efficiently in a fast-paced environment and manage multiple projects.
• Identify opportunities for internal and external collaboration.
• Motivate and lead multi-program teams and external committees/coalitions.
• Utilize computer software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems.

Physical Requirements

• Ability to visually read information from computer screens, forms, and printed materials.
• Ability to speak clearly in conversation and general communication.
• Hearing ability for verbal communication via telephone and face-to-face interactions.
• Manual dexterity for typing, writing, standing, reaching, flexibility, and body movement (bending, crouching, walking, kneeling, prolonged sitting).
• Lifting and moving objects, patients, or equipment weighing 10 to 25 pounds.

Pay

Pay Grade: 312 - $84,092 - $134,548 ($40.43 - $64.6865 per hour). The final salary offered will be based on education, job-related knowledge, experience, skills, and internal equity.

Benefits

• Comprehensive benefits package.
• CalPERS pension program and additional retirement packages.
• Generous PTO program.
• Work-life balance initiatives.
• Wellness programs.
• Tuition reimbursement.
• Professional and career development opportunities.
• Flexible scheduling.

Schedule

This position is approved for Full Telework (eligible in California only) or Partial Telework, requiring in-office presence at least two days per week in Orange, CA.