This position is responsible for the development and modification of CalOptima behavioral health policies and procedures in accordance with requirements from Department of Health Care Services (DHCS), Center for Medicare and Medicaid Services (CMS), and other regulatory entities. The incumbent will manage a portfolio of BHI policies, desktop procedures, and workflows that support the business operation of the department. The position will also be responsible for ensuring the department complies with all appropriate standards and regulations.
Develops and updates behavioral health policies and procedures
Reviews and tracks All Plan Letters (APLs) related to behavioral health
Tracks behavioral health related regulatory requirements to ensure ongoing compliance
Manages BHI department portfolio of workflows and desktop procedures (DTPs)
Manages reporting requirements for DHCS, CMS, and other regulatory entities
Serves as BHI liaison throughout audit activities as needed
Assists with drafting corrective action plans, developing project plans for implementing best practices and monitors progress to ensure desired results are achieved
Provides resolution to regulatory audit deliverables
Analyzes, develops, presents and oversees implementations for program and policy requirement per DHCS and CMS, process improvements, and data quality.
Develops and maintains process flows in collaboration with business unit(s).
Compiles reports for business functions, oversight, committees and regulatory requirements.
Other projects and duties as assigned.
Communicate clearly and concisely, both verbally and in writing.
Collect data, identify and analyze pertinent and salient information; prepare reports and presentations, with high attention to detail.
Organize and manage multiple projects, related activities and information.
Manage changing priorities in a fast-paced environment.
Understand the behavioral health delivery system and the impact of proposed regulatory policy and program changes.
Understand, interpret and analyze regulatory requirements and impact to business.
Implement new processes and/or workflows.
Objectively communicate analyses, opportunities for improvement and departmental risks.
Build and maintain effective working relationships.
Work independently, meet deadlines, set priorities and balance resources.
Utilize and access computer and appropriate software (e.g. Microsoft: Word, Excel, PowerPoint) and job-specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position.
Experience & Education:
Bachelor's degree in Public Health, Health Policy, Health Care, Public Policy Administration or other related field and/or an equivalent combination of education and experience required.
2 years of experience in a behavioral health setting strongly preferred.
3 years of experience at a health plan, in a medical group setting, public agency or hospital strongly preferred.
Behavioral health system of care.
Mathematical, statistical and operational research tools in order to produce valid reports.
Regulatory requirements from the Department of Health Care Services, Center for Medicare and Medicaid Services, and other entities.
Principles of effective analysis and report writing.
Principles and practices of health care systems and medical administration.
Grade: M #CB
Job Location Orange, California, United States Position Type Full-Time/Regular