Are you passionate about program management and behavioral health? Bring that passion to San Francisco Health Plan and help us improve the health outcomes of our members.
We are currently looking for a Behavioral Health Manager to lead the program. The Manager is responsible for managing the administrative aspects of all delegated and carved out behavioral health and substance use programs at the San Francisco Health Plan.
Delegated Behavioral Health Programs include:
- Non-specialty mental health and ABA services for Medi-Cal, which are currently delegated to a vendor, Beacon Health Options
- Behavioral health services for SFHP’s commercial product lines, Healthy Kids and Health Workers currently provided by the San Francisco Department of Public Health Behavioral Health Services (BHS)
Carved Out Programs: Substance Use and SMI
- County Behavioral Health and Substance use treatment services are “carved out” from SFHP’s Medi-Cal contract, but coordination and collaboration with BHS, Drug Medi-Cal and private substance use providers is a key factor in the success of SFHP’s care coordination and delivery of service.
A large component of the role involves coordination with, and oversight of vendor services, in partnership with multiple SFHP departments including Compliance, Provider Network Operations and Policy Development.
The Manager will act as the primary clinical liaison to both vendors and work collaboratively with SFHP partners to ensure Beacon and BHS 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).
In addition, the Manager will be responsible for creating and maintaining relationships with county and private substance use agencies. These relationships will allow our members to access substance treatment in a more uniform way and strengthen our program’s coordination with these agencies. The Manager will also participate in BHS/SFHP joint programs and activities
WHAT YOU WILL DO
Delegated Behavioral Health Oversight:
- In conjunction with CMO and clinical SFHP staff, develop, monitor and ensure successful completion of delegated contractual obligations including;
- Clinical Quality Program initiatives.
- Delegated quality, utilization management and credentialing requirements
- Act as the clinical point of contact, in collaboration with the Chief Medical Officer (CMO), and for the Beacon Contract Manager on the Beacon contract to ensure effective collaboration with Beacon Management team
Carved Out: Behavioral Health and Substance Use Services: SF County BHS
- Actively work to build and maintain a relationship with Treatment Access Program (TAP), the assessment, referral and placement unit of the Community Behavioral Health Services (CBHS), Community Programs - Placement Division
- Analyze substance treatment policy trends as relevant to SFHP members; update team on relevant developments
- Develop and maintain behavioral health and substance treatment policies and procedures as needed
- In collaboration with SFHP Grievance Review team, ensures behavioral health complaints and grievances are adjudicated appropriately.
- Provides primary oversight of Beacon investigation and response of such grievances; participates in SFHP Grievance Review Committee discussions of both Beacon grievances and as a subject matter expert on grievances with behavioral health components.
- Collaborates with SFHP’s Finance and Provider Relations staff and Beacon to analyze and ensure the SFHP behavioral health program meets overall financial targets.
- Support RFP process for and contract negotiations with behavioral health vendor as needed.
- Actively contributes to and participates in behavioral health audit preparation and sessions for DHCS, DMHC, and NCQA audits.
- Oversees and ensures that on-site Beacon staff is effective partner with SFHP staff, including Care Management, Customer Service, Clinical Operations, Pharmacy and Appeals and Grievances.
- Maximize partnership with Care Management Senior Program Manager to ensure all projects are appropriately resourced and executed successfully.
- Actively participate in all management level meetings, including: Care Management, Management Team, Health Services Management Team and SFHP Management Team
- Actively participate in and strategically use monthly Beacon- SFHP JAMs and Quarterly JAMS with County Behavioral Health
- Collaborate effectively with other departments including, but not limited to: Provider Network Operations, Information Technology, Business Analytics, Utilization Management, Customer Service, Compliance, Pharmacy and Marketing.
- Represents SFHP in meetings with key external constituents/stakeholders, including mental health and substance use provider organizations, Community Behavioral Health Services, DHCS staff, other Managed Care Organization (MCO) Behavioral Health directors, state policymakers, etc.
- Active member in Health Services Clinical Oversight Committee, responsible for developing and executing the plan’s key clinical quality/care management/pharmacy/utilization management initiatives for each year.
- As needed, participates in interdisciplinary clinical conferences, Quality Improvement Committee, Utilization Management Committee, and Pharmacy & Therapeutics Committee.
- Actively participates in SFHP trainings as needed.
- Develops and/or periodically updates SFHP behavioral health policies.
- Maintains privacy and confidentiality practices in accordance with regulations and program standards.
- In coordination with Delegation Oversight Staff, perform annual oversight audit of behavioral health vendors and delegated providers and review delegates’ corrective action plans.
- Participate in the review and update of Audit Tools.
WHAT YOU WILL BRING
- Bachelor’s degree in a related field or equivalent years of experience
- California licensed mental health or substance abuse clinician preferred
- Minimum of 3 years program management experience
- 2 years of experience in managing staff desired
- NCQA standards knowledge preferred.
- Experience with the audit process of clinical activities preferred.
- Experience working in quality management/improvement, preferred.
- PC proficiency; MS Office skills (Word, Excel, PowerPoint)
- Excellent communication skills with the ability to facilitate meetings
- Ability to work independently and as a part of a team.
- Strong organization, time and project management skills and multi-tasking abilities.
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.