Supervisor - Managed Services

JOB SUMMARY HealthRIGHT 360, a nonprofit organization and a family of programs, is committed to providing accessible and comprehensive healthcare services to vulnerable populations. Our mission is to tackle systemic barriers to healthcare and promote health equity for all. We offer a wide range of services, including mental health care, residential and outpatient substance use treatment, and primary health services. Additionally, we provide transitional support for individuals re-entering the community after involvement in the criminal justice system. By integrating physical and behavioral health, we empower individuals to overcome challenges by addressing social determinants of health, fostering resilience, and facilitating recovery.    CalAIM is an initiative of the Department of Health Care Services (DHCS) to improve the quality of life and health outcomes of Medi-Cal recipients by implementing delivery system, program, and payment reforms across the Medi-Cal program. A key feature of CalAIM is the statewide introduction of an Enhanced Care Management (ECM) benefit and a menu of Community Supports, which, at the option of a Managed Care Plan (MCP), publicly funded health insurance plans for low-income citizens, can address the clinical and non-clinical needs of Populations of Focus with the most complex medical and social needs.   Supervisor, Care Management will be responsible for implementing the ECM program to serve members under the Managed Care Plan (MCP) by providing care by linking clients with appropriate services to address specific needs such as physical and mental health, substance use disorder, (residential and outpatient) employment, Justice-Involved concerns, housing, community resources, and aftercare. The Supervisor, Care Management is required to identify and engage with each member in the community, including the member’s home, service provider locations and other, various locations requiring outreach. The Supervisor, Care Management will also hire, supervise, and train new staff incrementally, as the program grows to serve the expanding population.   KEY RESPONSIBILITIES Program Implementation & Development * Organize, stabilize, and integrate the new project by meeting with representatives from the funding source (e.g., Community Health Group, Molina, and other local MCPs). * Understand the needs of the population, referral and authorization processes, data-entry, and billing, to build a solid foundation for the program. * Create a framework that allows for community-based program expansion. * Organize patient care activities as outlined by the MCP and implement identified care coordination strategies. Engagement and Enrollment * Identify eligible individuals from State Prisons, County Jails, hospitals, and other locations for enrollment into MCP. * Utilize multiple engagement strategies including direct communication, community outreach, and street-level outreach. Client Care Activities * Organize client care activities. * Share information with the clients’ multi-disciplinary care team. * Implement activities identified in the MCP. * Provide support to engage clients in their treatment including medication review, appointment scheduling, transportation coordination, and addressing barriers to engagement. * Assist with intake by completing required assessments and care management plans. * Connect members to benefits, healthcare services, employment, housing, and community resources. * Monitor client’s progress toward achieving treatment plan goals and provide treatment plan input. Care Coordination * Maintain regular contact with all providers involved in the member's care team. * Ensure continuous and integrated care among all service providers. * Refer and follow up with primary care, mental health, substance use disorder treatment, and necessary community-based services. * Collaborate with clients and their families for community reintegration. * Collaborate with outside agencies to obtain needed community resources (housing, sober livings, substance abuse recovery agencies, medical facilities, employment/education agencies, DPSS, DMV or other needed resources). * Communicate collaboratively with all members of the behavioral health team. Field-Based Responsibilities * Meet ECM clients at their physical locations and cater to their individual needs. * Conduct case management activities in locations most attainable and desirable for clients. * Have access to office space for case management activities and attend required trainings and meetings as needed. * Submit mileage for field-based case management activities for reimbursement. * Services may be provided at clients’ homes, medical facilities, behavioral health providers, etc. People Supervision * Recruit, onboard, train, and terminate employees. * Provide supervision and guidance to staff as needed. * Ensure proper coverage by creating and modifying work schedules and approving time off requests. * Ensure staff are properly trained and in compliance with their position expectations, performance goals, and organization’s standards, policies, and procedures. * Provide ongoing feedback, manage performance of direct staff including providing performance improvement plans, formal written warning notices, and terminations if necessary. * Oversee clinical documentation for Lead Care Management staff as team expands, within a timely matter. Administration and Other Duties * Write and complete all progress notes within 24 hours of service delivery. * Write client progress letters and court reports. * Develop and maintain training-related workflows and procedures. * Actively participate in assigned Clinical Group Supervision, agency, and team meetings. * Participate in training opportunities and complete assigned training in a timely manner.   And perform other duties as assigned.   QUALIFICATIONS  Credentials and Experience * Option I: High school diploma or equivalent. * Minimum of 3 years’ experience working with Medi-Cal, Medi-Care, and private Medical Insurance plans. * Bachelor’s degree in a human services-related field. * Minimum of 1 year of supervisory experience in healthcare, social services, or community-based setting * Option II:  * Minimum of 3 years of case management experience working with high-need populations (Medi-Cal, Medi-Care, and private medical insurance plans).  * Two years’ demonstrated expertise in substance abuse treatment, relapse prevention, and recovery preferred. * Alcohol and Other Drug (AOD) registration or certification from CAADE, CADTP, or CCAPP desired. * Valid First Aid and CPR certification or ability to obtain within 30 days of hire. * Valid California Driver’s License and access to registered and insured transportation.

Description Position at Northwell Health Northwell is the largest not-for-profit health system in the Northeast, serving residents of New York and Connecticut with 28 hospitals, more than 1,000 outpatient facilities, 22,000 nurses and over 20,000 physicians. Northwell cares for more than three million people annually in the New York metro area, including Long Island, the Hudson Valley, Connecticut and beyond, thanks to philanthropic support from our communities. Northwell is New York State’s largest private employer with over 104,000 employees — including members of Northwell Health Physician Partners — who are working to change health care for the better Summary: Coordinates and monitors all aspects of Patient Financial Services daily functions, including billing compliance and accounts receivable functions. Responsible for the assigned areas claims submission, payment application, denial management, and account follow-up to ensure optimal reimbursement. Responsibilities: 1. Accurately processes claims, payments, rejections, refunds, credit balances and unapplied cash on a daily basis and performs timely follow-up. 2. Confirms electronic and hard-copy billing of any delinquent claims. Rebills and follow-ups of all delinquent claims. 3. Responds to all patient and payer inquiries, denials, correspondence and telephone inquiries. 4. Advises other areas of updated insurance information and claim denials, i.e., registration. 5. Follows through with education of rules and regulations in the managed care system, as well as State & Federal guidelines. 6. Adjusts account balances to specific account needs. 7. Maintains Contract Management reporting (i.e., payment errors, carve out billings) and updates any information as needed or requested by supervisor. 8. Responsible for reviewing and resolving patient/insurance credit/debit balances and ensure proper communication is delivered to the patient. 9. Adheres to all policies and procedures related to federal, state and department compliance for the position. 10. Maintains and Model the Organizations values. 11. Demonstrates regular, reliable and predictable attendance. 12. Performs other duties as required. Education Skills Experience: High School Graduate or Equivalent required.   Data entry and customer service experience preferred. Six months minimum experience in billing and collections is preferred Medical Office/Healthcare experience preferred. Company: Nuvance Health Org Unit: 1785 Department: Patient Accounting Exempt: No Salary Range: $19.54 - $29.00 Hourly