Clinician Sr, Behavioral Health - Clinical/Care Management - Covered California (Clinician Sr)

About the role

The Clinician Sr, Behavioral Health - Clinical/Care Management position at CalOptima is seeking a highly skilled professional to join the Behavioral Health Integration team. This role is full telework eligible, with the requirement to come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

Responsibilities

• Participates in a mission-driven culture of high-quality performance, focusing on customer service, consistency, dignity, and accountability.
• Collaborates with the team to support short- and long-term goals/priorities for the department.
• Reviews and evaluates proposed services using established policies and procedures.
• Analyzes requests with the goal of monitoring utilization of services, including medical appropriateness, and identifies high-cost complex cases for high-level case management intervention.
• Conducts thorough and objective assessments of members' status for short-term cases, gathering all pertinent information.
• Develops and implements member-specific care plans and maintains appropriate documentation of patient care and progress.
• Evaluates members' progress regularly, schedules follow-ups, and adjusts care plans, providers, and services as necessary to promote better outcomes.
• Establishes communication and collaboration methods with other team members, physicians, community agencies, and administrators.
• Advocates for clients' interests for necessary funding, treatment alternatives, timelines, and coordination of care.
• Documents case notes and rationale for all decisions.
• Coordinates and collaborates between behavioral health providers, health networks, IPAs, and CalOptima Health departments for problem resolution and service integration.
• Serves as a resource and provides guidance to CalOptima Health staff.
• Completes telephonic behavioral health screenings, triages for members with behavioral health needs, provides complex care coordination, and takes escalated calls.
• Coordinates referrals when appropriate to the County Behavioral Health Plan for members who may need additional mental health and/or behavioral health case management support.
• Supports members in navigating the behavioral health systems of care.
• Assists with training for new Behavioral Health Clinicians.
• Supports the implementation of department and agency initiatives to enhance member care.

Requirements

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

Qualifications

• Develops rapport and establishes effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
• Works independently and exercises sound judgment.
• Communicates clearly and concisely, both orally and in writing.
• Manages multiple projects and identifies opportunities for internal and external collaboration.
• Motivates and leads multi-program teams and external committees/coalitions.
• Utilizes computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Physical Requirements

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