Clinical Manager of Medi-Cal Operations

LifeMoves - San Jose, CA (30+ days ago)4.5

Full-time

The Clinical Manager of Medi-Cal Operations is responsible for driving key elements of LifeMoves’ Medi-Cal program to ensure that the program meets clinical/service, quality, and billing targets. This position provides direct clinical and administrative oversight to Case Managers and Master of Social Work Interns working on Medi-Cal contracts and also works collaboratively with Program staff within the organization to ensure that Medi-Cal operational requirements are met and that optimal business processes are implemented and maintained. This individual will also provide diagnosis and assessment of medical necessity/treatment authorization for clients eligible for Medi-Cal services, and will co-sign and provide feedback around notes and services provided by staff and interns.

Position responsibilities:

  • Diagnose clients to determine medical necessity regarding Medi-Cal services.
  • Review quality of assessments, treatment plans, and progress notes, co-signing for staff and interns as needed, for clients being served under Medi-Cal contracts.
  • Provide technical assistance to MSW Interns and Case Managers regarding Medi-Cal policies and procedures and documentation requirements.
  • Oversee and execute all quality assurance activities on the Medi-Cal program.
  • Ensure that all Case Managers working on Medi-Cal contracts meet requirements in terms of training and credentials. Coordinate all training activities, including clinical and/or mental health-related training as appropriate.
  • Ensure that formal, written policies and procedures are implemented and maintained for operational areas that support the Medi-Cal contracts. Work collaboratively with other functional organizations to ensure their understanding and compliance with the policies and procedures.
  • Ensure that electronic records on LifeMoves’ Voyager system are accurate and meet Medi-Cal requirements.
  • Work with finance staff to ensure billing on Medi-Cal contracts is executed in a timely and accurate manner.

Position Qualification:

  • A California license in social work (LCSW), or another professional mental health license (LMFT, LPCC, Licensed Psychologist) is required.
  • At least one year of experience in overseeing clinical services in a mental health context
  • At least one year experience in mental health assessment and diagnosis
  • Knowledge/understanding of “leading practices” in Medi-Cal managed care.
  • Knowledge of Medi-Cal reimbursement, regulations and requirements strongly preferred.

About LifeMoves

  • LifeMoves provides transitional housing and services to homeless people through our 17 sites in San Mateo and Santa Clara Counties. We are an organization with total funding of $23M, received from Federal, County, and local governments as well as private and foundation donors.

Job Type: Full-time

Experience:

  • mental health assessment and diagnosis: 1 year (Preferred)
  • overseeing clinical services in a mental health context: 1 year (Preferred)
  • Medi-Cal reimbursement, regulations: 1 year (Preferred)
  • Medi-Cal Operations: 2 years (Required)

Education:

  • Master's (Required)

Location:

  • San Jose, CA (Preferred)

License:

  • LCSW, LMFT, LPCC (Required)