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Member Liaison Specialist

Company CalOptima
Location Orange, CA
Update 11 Day ago
The position is responsible for assisting members with behavioral health care management needs, which includes, but not limited to, securing behavioral health appointment for members, following up with members before and after appointment, providing member information and referring to community resources, conducting utilization review, and assisting member in navigating the mental health system of care. This position will act as a consultative liaison to assist members, health networks and community agencies to coordinate behavioral health services.

Position Responsibilities:
Assist members in securing behavioral health services appointments.

Provide ongoing care management support for members receiving behavioral health services.

Coordinate member’s behavioral and social service needs both within and outside CalOptima to ensure the coordination of member’s care.

Collaborate and communicate with the member, family, conservators, significant other(s), physicians, health networks and other health care providers to support and accomplish goals identified.

Act as an advocate to assist in the coordination of the member’s identified psychosocial needs, utilizing community resources and support when appropriate.

Develop and maintain a network of current community resources and services where members can be referred to for assistance. Maintain documentation of member cases within the Medical Management System and Facets, as needed.

Initiate referrals to both internal and external care management departments, and other government agencies.

Other projects and duties as assigned.

Required Skills

Develop rapport, establish and maintain effective interpersonal relationships with internal and external contacts at all levels.

Adhere to CalOptima policies/procedures (i.e. PHI/HIPAA).

Develop creative/innovative approaches to challenges and opportunities.

Prepare comprehensive written reports and maintain accurate records. Prepare and provide effective orientations and educational presentations.

Work with appropriate departments to expedite the resolution of member concerns.

Remain knowledgeable of the available health plans and CalOptima’s benefit structure.

Communicate effectively, both verbally and in writing with individuals from varying cultural and ethnic backgrounds.

Effectively utilize computer and appropriate software.

Required Experience

Experience & Education:
High school diploma or equivalent required.

Bachelor's degree in behavioral health or related field is preferred.

2 years of experience in behavioral health, community services, or other social services setting required.

Customer/member services experience preferred.

HMO, Medi-Cal/Medicaid and health services experience preferred.

Driver’s License and vehicle or other approved means of transportation may be required for some

Bilingual in English and in one of CalOptima's defined threshold language is preferred.

Knowledge of:
Issues that face members with behavioral health needs.

Principles and practices of health care service delivery and managed care.

Principles and techniques for effective communication and education.

Appropriate techniques to serve the population in diverse social and ethnic groups.

Appropriate methods and techniques to track and respond to service related complaints and grievances.

Specialized expertise in particular area of service may be required for assignments.

Personal computers, keyboarding, and appropriate software to produce correspondence, charts, spreadsheets, and/or other information applicable to the position.

Grade: I