Program Manager, Sr. (Behavioral Health)
CalOptima is a county organized health system that administers publicly funded health care coverage for low-income children, adults, seniors and people with disabilities in Orange County, California. CalOptima’s mission is to provide members with access to quality health care services delivered in a cost-effective and compassionate manner. With $3.6 billion in annual revenue, CalOptima serves nearly 800,000 members, delivering services through four programs, Medi-Cal, OneCare Connect, OneCare and PACE. For the past six years, CalOptima has been rated the top quality Medi-Cal plan in California, according to the National Committee for Quality Assurance (NCQA) Medicaid Health Insurance Plan Ratings 2019–2020.
The Program Manager (PM) Sr. is responsible for regulatory requirements governing authorization processing, monitoring utilization patterns, and developing behavioral health utilization management work plan. The incumbent works under the direction of the Director of Behavioral Health Services (Integration), Medical Director of Behavioral Health and/or other department leadership to support the department’s UM activities. The incumbent will also play a vital role in the program design, development, and implementation of behavioral health related programs. The position will be responsible for the overall direction, coordination, implementation, execution, control and completion of tasks supporting new program development.
Bachelor’s degree in a behavioral health related field required; Master’s degree in Health Administration, Social Work, Marriage and Family Therapy,
Public Health, or other related degree preferred.
2 years’ experience in new program development for vulnerable populations, including strategic planning for a start-up program and implementing the
2 years’ experience and aptitude for working in a highly matrixed, mission-driven organization required.
4 years’ experience working in a managed care environment, with specific experience in behavioral health utilization management preferred.
Experience in a government or public environment strongly preferred.
CalOptima’s Program Manager. Sr. must possess the ability to:
Communicate clearly and concisely, both verbally and in writing, including presentations.
Systematically evaluate work and apply skills to continuously improve processes.
Manage multiple deadlines in a fast-paced environment.
Initiate and follow through on projects with minimal supervision.
Think critically to solve problems effectively.
Work independently and as an effective member of a team.
Demonstrate excellent analytical, interpersonal, organizational, and writing skills.
Provide innovative approaches to challenges and opportunities.
Utilize and access computer programs and appropriate software (e.g. Microsoft Office; Word, Excel, Outlook, PowerPoint) and job specific applications
such as Guiding Care and MCG Health CareWeb.
CalOptima’s Program Manager. Sr. must have the knowledge of:
Detailed knowledge of departmental procedures, policies, and clinical guidelines relative to behavioral health utilization management and authorization
Culture and needs of the socially and ethnically diverse population CalOptima serves.
Principles and practices of health care, health care systems, and managed care.
Medi-Cal benefits and regulations.
Behavioral health and experience in developing, implementing and evaluating evidenced-based programs.
Managed care, Medicare, and Medi-Cal, with some experience in applying the appropriate regulations and guidelines to behavioral health care services.
Principles of managed health care service delivery.
For a complete job description and to apply online, please go to www.caloptima.org. Questions can be directed to Debbie Neal, Senior Recruiter, 657-235-6891.Position Description »