Are you passionate about program management and behavioral health? Bring that passion to San Francisco Health Plan and help us grow our newest member offering!
As the Program Manager of Behavioral Health you will be responsible for managing the mental health programs at the San Francisco Health Plan. This includes:
- Non-specialty mental health services for Medi-Cal, which are currently delegated to our partner, Beacon Health Options
- Behavioral health services provided by the San Francisco Department of Public Health Community Behavioral Health Services (CBHS) for Healthy Kids and Healthy Workers
As these services are delegated to external partners, a large component of the role involves coordination with, and oversight of vendor services, in partnership with multiple SFHP departments. You will function as the primary clinical liaison to both vendors and work collaboratively with SFHP partners to ensure Beacon and CBHS successfully meet the goals established by SFHP and the regulatory requirements promulgated by the Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), and the National Committee for Quality Assurance (NCQA).
WHAT YOU WILL DO
- Act as the clinical point of contact, in collaboration with the Chief Medical Officer (CMO), and for the Beacon Contract Manager to ensure:
- Contract goals are created, monitored and successfully completed.
- Delegated quality, utilization management and credentialing performance meets aforementioned requirements.
- Effective collaboration with the Beacon management team.
- Collaborate with SFHPs Provider Relations Network Manager to set agendas and ensure follow-up to the quarterly/monthly Joint Administrative Meetings (JAMs) with behavioral health providers.
- Partner with the CMO and other Health Services Directors to effectively integrate SFHP’s behavioral health benefit into SFHP’s Care Management program.
- Collaborate with Beacon and SFHP Provider Network Operations to ensure effective, accessible behavioral health programs are in place.
- Partner with Care Management’s (CM) Strategic Partnerships Program Manager to build relationships with and integrations for substance use and housing providers.
- Coordinate with the CM Children and Family Program Manager to provide oversight and triage issues relating with member’s connection to Behavioral Health Therapy (BHT).
- Actively communicate with the CM program management (PM) staff, ensuring standard documentation and adherence to PM best practices.
- In collaboration with SFHP's Grievance Review team, ensures behavioral health complaints and grievances are adjudicated appropriately.
- Collaborate with SFHP’s Finance and Provider Relations staff and Beacon to analyze and ensure the SFHP behavioral health program meets overall financial targets.
- Actively contribute to behavioral health audit preparation (DHCS, DMHC, and NCQA audits).
- Oversee and ensure that on-site Beacon staff are effective partners with SFHP staff.
- Effectively represent SFHP in meetings with key external constituents/stakeholders.
WHAT YOU WILL BRING
- Masters’ degree in Social Work or Psychology
- Must be a California licensed mental health or substance abuse clinician.
- Minimum of 3 years program management experience.
- Demonstrated project management expertise.
- Superior written and verbal communication skills.
- Ability to collaborate effectively on cross-functional teams.
- Expert critical thinker and problem solver who can effectively communicate solutions to a broad audience.
- Experience with the audit process of clinical activities preferred.
- Experience working in quality management/improvement, preferred.
- Knowledge of NCQA standards preferred.
Established in 1997, San Francisco Health Plan (SFHP) is a an award winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco county. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 145,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services. SFHP was designed by and for the residents it serves, and takes great pride in its ability to accommodate a diverse population that includes young adults, seniors, and people with disabilities.
San Francisco Health Plan is an Equal Opportunity Employer (EOE) M/F/D/V
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.