Community Based Service Specialist - Santa Clara Family Health Plan : Job Details

Community Based Service Specialist

Salary Range: $72,385 - $108,578 The expected pay range is based on many factors, such as experience, education, and the market. The range is subject to change.

FLSA Status:Non-exempt Department:Long Term Services and Supports (LTSS) Reports To:Manager, SDOH or Manager, Community Based Case Management

Employee Unit: Employees in this classification are represented by Service Employees International Union (SEIU) Local No. 521

GENERAL DESCRIPTION OF POSITION

The Community Based Services Specialist serves as the lead, primary contact, and liaison for developing, supporting and monitoring the network of public and community based providers and vendors delivering Enhanced Care Management (ECM), Community Supports (CS), and/or other activities, programs or special projects addressing social determinants of health.

ESSENTIAL DUTIES AND RESPONSIBILITIES

To perform this job successfully, an individual must be able to satisfactorily perform each essential duty listed below.

Develop and maintain updated knowledge of community based services, and capacity across Santa Clara County and support identification and assessment of ECM and/or CS provider network gaps.

Recommend for initial and ongoing needs to support ECM and/or CS delivery system and operational infrastructure including data exchange, workforce training and capacity building.

Support ECM and/or CS authorization and delivery process in accordance with DHCS-developed service definitions, eligibility criteria and reporting requirements.

Oversee the development and management of the ECM, SDOH and/or CS provider network including:

• Serve as a knowledge and resource expert for ECM, CS and/or SDOH provider network operations.
• Establish and manage positive and productive working relationships with all public and community-based providers and vendors delivering services to members under ECM, CS or SDOH projects.
• Receive, research and respond to inquiries and issues that are raised by or impacting providers in a timely fashion and in collaboration with appropriate business units.
• Proactively communicate and collaborate with providers to identify problem patterns, track and trend issues, prepare recommendations for potential service improvement opportunities and develop tools and processes to improve communication and other processes
• Oversee collaboration with internal business units, particularly Provider Network Operations, Health Services Department, Finance and Claims, regarding provider communication, training and support and to ensure payments are made in accordance with vendor agreement terms.
• Schedule, conduct and report on regular site visits with each provider as required and coordinate and host at least one annual meeting with providers.
• Conduct orientation and ongoing training and education to community service providers and office staff including technical assistance, development of presentations and other written guidance or materials, in-person sessions, webinars and/or calls as needed.
• Assist in the preparation of promotional materials for the public, website or newsletters. Oversee provider compliance with required ECM and/or CS trainings and technical assistance including in-person sessions, webinars, and/or calls as necessary.

Establish and oversee a program for communicating and tracking ECM and/or CS provider compliance with vendor agreement scope of work, key operational and financial objectives, and quality and performance metrics.

Maintain accurate and timely documentation of provider contacts in compliance with NCQA standards, DHCS, DMHC and CMS regulatory requirements.

Contribute to the development of ECM and/or CS pricing including recommending changes in pricing subsystems.

Support the Department Manager in generating reports and performing special projects. Troubleshoot with providers to address issues related to submission of claims and encounter data for ECM and/or CS services.

Understand and track applicable regulatory and reporting requirements.

Ensure accuracy and regulatory compliance for all materials or documents.

Attend off-site meeting or events as necessary.

Perform other related duties as required or assigned.

REQUIREMENTS - Required (R) Desired (D)

The requirements listed below are representative of the knowledge, skill, and/or ability required or desired.

Bachelor's Degree in public health, social welfare or related field; or equivalent experience, training, or coursework. (R)

Minimum two years of progressively responsible and direct work experience working with the essential duties and responsibilities described above. (R)

Demonstrated experience leading/managing projects, initiatives, and/or leading or directing the work of others. (R)

Knowledgeable in the field of home and community-based services and community resource networks and a particular interest in working to address health disparities and addressing the needs of low-income communities.

A deep understanding of SDOH that impact Santa Clara County and community members. (R)

Ability to think creatively and work strategically, to help develop and implement innovative solutions yielding measurable results to the organization. (R)

Ability to think creatively and strategically, gather and analyze data, organize and write reports, organize work efficiently. (R)

Ability to understand, interpret, and apply applicable rules and regulations, and establish and evaluate priorities. (R)

Advanced working knowledge and proficient with Microsoft Suite applications, and the ability to operate all applicable software. (R)

Excellent oral and written communication skills, including the ability to express oneself clearly and concisely when providing service to SCFHP internal departments and outside entities over the telephone, in person or in writing.(R)

Ability to effectively facilitate meetings and deliver information/presentations to management, regulators, or staff (R).

Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)

Ability to take initiative and exercise good judgment when making decisions within the scope of the position. (R)

Ability to comply with all SCFHP policies and procedures. (R)

Ability to perform the job safely with respect to others, to property, and to individual safety. (R)

Maintenance of a valid California driver's license and acceptable driving record, in order to drive to and from offsite meetings or events; or ability to use other means of transportation to attend offsite meetings or events. (R)

Knowledge of the community-based delivery system and managed care. (D)

Project Management Professional (PMP) certification (D)

WORKING CONDITIONS

Generally, duties are primarily performed in an office environment while sitting or standing at a desk. Incumbents are subject to regular contact with co-workers, managers, external partners, and vendors, in person, by telephone, and via work-related electronic communications.

PHYSICAL REQUIREMENTS

Incumbents must be able to perform the essential functions of this job, with or without reasonable accommodation:

Mobility Requirements: regular bending at the waist, and reaching overhead, above the shoulders and horizontally, to retrieve and store files and supplies and sit or stand for extended periods of time; (R)

Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)

Visual Requirements: ability to read information in printed materials and on a computer screen; perform close-up work; clarity of vision is required at 20 inches or less; (R)

Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (note-taking); ability to operate a computer keyboard and other office equipment (R)

Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)

Reasoning Requirements:ability to think and work effectively under pressure; ability to effectively serve customers; decision making, maintain a concentrated level of attention to information communicated in person, by telephone, and electronically, throughout a typical workday; attention to detail. (R)

ENVIRONMENTAL CONDITIONS

General office conditions. May be exposed to moderate noise levels.

EOE