Health Insurance Operations Manager jobs in Santa Barbara, CA

Company Description

Looking for a career that makes a difference in people’s lives?  CenCal Health is a locally-run, not-for-profit health plan that serves nearly 180,000 people, with offices in both Santa Barbara and San Luis Obispo Counties.  For 35 years we’ve been improving the health and well-being of our neighbors through partnership and collaboration, and we’re looking for exceptional, mission-driven professionals to help us grow. We are an employer of choice in Santa Barbara, offering competitive salaries, generous vacation & holidays, comprehensive health/dental/vision benefits including a CalPERS pension plan and 457 deferred income plan, a wellness program, a gym in our headquarters and even parking lot BBQs. Come join our group of nice people doing good work at a great company. 

For more information on who we are and what we do, please visit our website at www.cencalhealth.org

Job Description

Job Location: Santa Barbara Office 4050 Calle Real, Santa Barbara, CA 93110

Salary Range: $103898.00 – $161043.00 /year

Position Type: Full-Time

• Monday to Friday
• Hybrid 2 days per week

Benefits:

• Pension Plan
• Professional Development and Wellness Benefits
• Alternative Transportation Incentives
• Comprehensive medical, dental, vision & life insurance
• Paid Time Off
• Ten (10) paid holidays per year

Apply Now: https://www.paycomonline.net/v4/ats/web.php/jobs/ViewJobDetails?job=83337&clientkey=596BEB0B80DDF299C4E06A78967BCA73

Job Summary

The Behavioral Health Operations Manager is responsible for planning, organizing, and managing the daily operations of the Behavioral Health (BH) Utilization Management (UM) and Care Coordination team. The Operations Manager is responsible for inventory management, including meeting key performance indicators and regulatory requirements. The position contributes to maintaining up-to-date program descriptions, policies, and procedures; participates in special assignments, audits, and focus projects; and performs related work as assigned.

Duties and Responsibilities

• Plan, develop, and oversee Behavioral Health (BH) Utilization Management (UM) and Care Coordination team functions and activities.

• Creates controls to monitor and track key performance indicators.

• Manages inventory, productivity, and staffing to ensure key performance indicators and regulatory requirements are met.

• Creates staffing models, productivity, and quality standards for team functions.

• In collaboration with Master Clinical Trainer, identify training and efficiency opportunities.

• Create and update Policies and Procedures in support of UM and Care Coordination functions.

• Review and optimize workflows to support efficient and effective processes.

• In collaboration with the Director of Behavioral Health, ensures the appropriate and timely use of Utilization Management criteria and guidelines and medical policy in the administration of treatment to CenCal Health members.

• Supports the Behavioral Health Department staff that report directly to the Behavioral Health Operations Manager with specialized knowledge of chronic co-morbid condition management, care integration, transitions, referral management, and all other aspects of care management and care coordination as it relates to mental and behavioral health.

• Participate in internal and external audits.

• Participate in State Fair Hearings as requested

• Analyze and prepare regular reports of BH Utilization Management and Care Coordination activities.

• Collaborate with Information Technology (IT) in the development of electronic health records, functionality, and reports.

• Provide guidance to providers and members related to timely requests, authorization requirements, etc.

• Internal meetings leading solutions-oriented approach to improve transitions of care, coordination, and health care delivery system.

• Act as a liaison to internal and external customers for prompt resolution of issues.

• Provide input for projects and programs within the Health Services Department.

• Ensure the unit meets all departmental, regulatory, and contractual compliance goals.

• Attend County and other external meetings as assigned.

• Facilitate monthly/as-needed provider training on behalf of the department-including creating content

• Monitor staff productivity and compliance.

• Serve on agency committees.

• Other duties as assigned.

Qualifications

Education and Experience

Required:

• A current, active, and unrestricted California license as an R.N., LCSW, LMFT, LPCC.

• Minimum of 2 years of experience in a supervisory position in a managed care setting or county behavioral health

Preferred:

• Experience in a managed care setting

Additional Information

All your information will be kept confidential according to EEO guidelines.