Member Services Supervisor Behavioral Health/Job Req 704962823

Alameda, CA, United States

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 specialist's 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 Alliance's 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 & 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 Managers 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 (G&A) 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 expectations and make recommendations for improvement.

Evaluates policies and procedures and analyze/recommend enhancements to ensure adherence to regulatory requirements.

Assists with ensuring consistent data collection from MS staff that is used to assist the company in achieving strategic goals to improve monitoring and reporting to meet external requirements

Assists in writing and implementing business requirements for any software systems used in the Customer Administration Management, Call Center Applications and Grievances (HealthSuite/QualitySuite/Cisco Finesse/Calabrio, etc.) processes

Maintain records of training activities and employee progress.

Assist with revisions to Policy and Procedure and work process development.

Participate in Member Services Leadership/Operations meetings

Prepares for and participates in regulatory audits and develop and monitor corrective actions plans.

Completes other duties and special projects as assigned.

ESSENTIAL FUNCTIONS OF THE JOB:

Manages staff: Maximize staff performance on efficiency and productivity. Train, coach, motivate, and update staff on policy and process changes.

Collaborate with the BH, Grievance and Appeals Team on revieing and adjudicating behavioral health complaints and grievances.

Promotes a positive member experience, acts as an innovative problem solver, and helps the team arrive at long-term solutions to meet the needs of our members

Embraces accountability, strong work ethics, and integrity

Writing, reporting, administration, and analysis

Communicating effectively and efficiently internally and externally.

Developing long and short-range strategic plans for member services activities

Making verbal presentations.

Act as a resource to staff in daily coaching and problem-solving.

Leading and participating in internal and external committees and meetings.

Complying with the organization's Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

Perform all the functions of an MLS in times of high call volumes or staff shortage.

Coordinates the activities of professional and technical staff with other supervisors for caseload (EG) management and meeting timelines; interacts with staff to resolve issues; provides coverage as needed

Recruit, hire, and perform retention analysis and resolution.

Call center system monitoring, testing, and maintenance

Handling escalated and behavioral crisis

Measuring and improving customer satisfaction levels

Oversee processes for serving members who request assistance in person (walk-ins).

PHYSICAL REQUIREMENTS

Constant and close visual work at desk or on a computer.

Constant sitting and working at a desk.

Constant data entry using multiple monitors, keyboard and/or mouse.

Frequent use of telephone headset.

Frequent verbal and written communication with staff and other business associates by telephone, correspondence, or in

Frequent lifting of files, binders and other objects weighing between 0 and 30 lbs

Frequent walking and standing

Occasional driving of automobiles

Number of Employees Supervised: 15-20

Number of Direct reports: 7-10

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO

Bachelor's degree required or combination of education and equivalent

High School Diploma or GED required.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

Two to three years healthcare or behavioral health related experience preferred

Two years' experience in a Supervisor, Trainer, Quality Assurance or Auditor role highly preferred

Two to Three years call center customer service experience in a health care setting preferred

Internal Applicants:

Two to Three years' experience as an MSR III/MLSBH (maintaining 95% or higher department performance metrics for 12 months average over a 2-year period; and above or outstanding annual performance evaluation average rating).

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

Experience working with Medi-Cal Managed Care Plans (MCPs) Medicare, and health services experience preferred.

Ability to motivate, train, and supervise

Plan, supervise, review, and evaluate the work of staff

Interpret, explain, and apply regulations, policies, and procedures

Communicate effectively both orally and in writing

Ability to Plan, prioritize and organize

Analyze, evaluate, and make sound decisions

Prepare clear, accurate and effective reports, correspondence, and other written materials

Demonstrate interpersonal sensitivity and work with a diverse population

Establish and maintain effective work relationships

Proficient in DHCS/DMHC grievance processing procedures.

Working knowledge of contact center phone systems and customer management/auditing applications (Cisco Finesse, CUIC, UCCX, Calabrio, RAM-Healthsuite) desireable.

Intermediate to advanced Microsoft office skills (MS Word; MS Excel; MS PowerPoint; MS Outlook; MS Teams).

Be a strong collaborator and consensus builder with exceptional organizational skills and a demonstrated ability to plan and organize work for self and others in order to ensure that work is completed efficiently and in a timely manner

Capable of building trust and interacting with others in a way that gives them confidence in one's intentions and those of the organization.

Ability to be an effective communicator who conveys information and ideas to individuals or groups in a manner that meets audience needs; who can develop and maintain effective relationships with others; and who relates well to people of diverse cultures, interpersonal styles, abilities, motivations, or backgrounds.

Have a focus on customer driven results and a belief that the customer perspective should be a driving force behind business decisions and activities.

Be a practiced problem solver with good judgment, capable of thinking logically, taking initiative and reacting calmly under pressure in order to arrive at sound conclusions

Ability to handle multiple projects and balance competing priorities

Ability to act as resource to department staff

Knowledge of BHT and ASD Services

Knowledge of ancillary and hospital-based services

Current driver's license, automobile insurance, and car registration required

Proficient experience in Windows including current Microsoft Office suite.

Experience working with and monitoring ACD systems

HMO, Medi-Cal/Medicare, and managed health care services experience preferred

Bilingual in English and in one of AAH's defined threshold language (Cantonese, Mandarin, Spanish, Vietnamese, Tagalog) preferred.

SALARY RANGE $92,051.06-$138,076.59 ANNUALLY

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.

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