Salary Range: $50,216.00 (Min.) - $59,008.00 (Mid.) - $75,324.00 (Max.)
Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members in five health plans, we make sure our members get the right care at the right place at the right time.
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Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.Job Summary
The Behavioral Health Services (BHS) Coordinator II supports the department by handling the administrative functions of the behavioral health services/ continuity of care/specialty liaison process including intake, logging, tracking and status follow-up. This position will assist members with accessing the Behavioral Health services. This position will handle and coordinate the identification, documentation, investigation and resolution of behavioral health services related issues and will ensure issues are handled in a timely manner. This position works in a team environment on the planning, coordinating and evaluating of programs and activities related to Behavioral Health Services. The position professionally and efficiently handles Behavioral Health Services intake activities and accurately documents all activities per department policy, including entry into L.A. Care systems. This position regularly interacts with providers, vendors and other L.A. Care providers to assist in the care coordination of L.A. Care members.
Duties
Provides non-clinical support to the Behavioral Health Services Specialist that includes the technical aspects of the time sensitive processes for initiating cases, managing referral documentation, referrals, entering pre-certification/continued authorizations, identifying and responding to urgency of the request, appropriate documentation, case routing and tracking, routing of information, performing computer data input, faxing, filing of confidential member information, and maintaining logs of activity, etc.
Performs non-clinical medical review of referrals; forwards clinical or medical necessity reviews to Behavioral Health Services Manager or the BHS Specialist, as appropriate; works collaboratively with other BHS staff to research and resolve member and provider issues; acquires authorization specifically designated services, based on L.A. Care BHS policy, that do not require medical necessity review.
Assists in telephonic outreach calls to members identified through health risk assessments in need of care coordination assistance. Consists of follow-up calls to members to administer screening or obtaining clarification on initial responses.
Reviews BHS invoices and follows payment process to be paid timely; Gathers data for members who are enrolled in BHS. Runs monthly reports of paid invoices, members enrolled and disembroiled in BHS. Develops necessary database and runs comparative analysis reports between data files submitted by providers. Reconciles eligibility data.
Actively identifies and implements efforts to improve the quality, effectiveness and efficiency of job functions. Assist with special projects, data collection, calendaring, scheduling meetings and appointments. Maintains an efficient filling system, coordinates meetings, creates agendas and takes meeting minutes.
Duties Continued
Ensures BHS-related complaints and grievances are addressed timely and tracked regarding eligibility determinations, assessments, and care delivered by L.A. Care's contracted providers. Works with LA Care providers and reviews assessment data and care plans to ensure member's services are not duplicated.
Follows policies, procedures and systems process to identify L.A. Care members eligibility. Adheres to policy for transmitting data and sharing care plans and other information relevant to these L.A. Care members’ care between L.A. Care departments and the contracted organizations.
Perform other duties as assigned.
Education Required
Education Preferred
Experience
Required:
At least 0-1 years of managed care authorization process and/ or working with mental health and/or substance use consumers and/or any disadvantaged/under represented ethnic populations and/ or working in the non-profit, medical, or clinical sectors, case management information technology systems.
Skills
Required:
Knowledge of local community based organizations, agencies and community services.
Knowledge of medical terminology and ICD-10 and CPT codes.
Strong verbal and written communication skills.
Proficiency with Microsoft Word, Excel, and Access.
Excellent organizational, interpersonal and time management skills.
Must be detail-oriented and a team player.
Able to interface with members, medical personnel, and other internal and external agencies and sometimes convince/persuade others to comply with L.A. Care requirements and provide information in a timely fashion.
Licenses/Certifications Required
Licenses/Certifications Preferred
Required Training
Physical Requirements
Additional Information
Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.
L.A. Care offers a wide range of benefits including
- Paid Time Off (PTO)
- Tuition Reimbursement
- Retirement Plans
- Medical, Dental and Vision
- Wellness Program
- Volunteer Time Off (VTO)
