Community Based Program Specialist

Santa Clara Family Health Plan; San Jose (CA); On-site; USD 76,000 - 115,000; Full time

Job summary

Santa Clara Family Health Plan is seeking a Community Based Program Specialist to lead and support the ECM, CS, and CHW networks across Santa Clara County.

The role focuses on coordinating provider relationships, monitoring performance, and ensuring compliance with DHCS definitions and reporting. Travel to offsite sites may be required, with emphasis on collaboration across departments.

Qualifications

• Bachelor's degree in public health, social welfare or related field.
• Minimum two years of progressively responsible and direct work experience.
• Demonstrated experience leading/managing projects.
• Knowledge of home and community-based services and resource networks.
• Deep understanding of social determinants of health (SDOH).
• Ability to think creatively and strategically; data gathering and reporting.
• Understand and apply regulatory rules and prioritize tasks.
• Advanced working knowledge of Microsoft Office; proficient in software tools.
• Excellent oral and written communication; able to present to diverse audiences.
• Ability to facilitate meetings and deliver presentations.
• Decision making under pressure; initiative and good judgment.
• Policy compliance and safety awareness.
• CA driver’s license and willingness to travel for offsite meetings.
• Knowledge of community-based delivery systems.
• PMP certification (desirable).
• Office software proficiency (Outlook/Word/Excel).

Responsibilities

• Develop and maintain ECM/CS/CHW provider networks across Santa Clara County.
• Coordinate data exchange, training, and capacity building.
• Ensure ECM/CS/CHW activities align with DHCS definitions and reporting requirements.
• Oversee provider network management and relationships with vendors.
• Conduct regular site visits and provider trainings; prepare guidance materials.
• Track compliance with agreements, objectives, and performance metrics.
• Assist with reports and special projects for the Department Manager.
• Troubleshoot provider issues related to claims and data submission.
• Collaborate with internal departments to ensure timely payments under vendor terms.

Skills

Project leadership

SDOH knowledge

Data analysis

Report writing

Creative thinking

Regulatory understanding

Communication

Meeting facilitation

Decision making

Policy compliance

Driver's license

Community-based delivery knowledge

PMP certification

Office software (Outlook/Word/Excel)

Education

Bachelor's degree in public health or related field

PMP certification (desirable)

Tools

Microsoft Office Suite

Outlook

Word

Excel

Job description

Community Based Program Specialist

Salary Range: $76,346 - $114,519
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: Community-Based Programs

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 Program 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 Community Health Worker (CHW), 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.

1. Develop and maintain updated knowledge of community-based services, and capacity across Santa Clara County and support identification and assessment of ECM, CS, and/or CHW provider network gaps.
2. Identify initial and ongoing needs to support ECM, CS, and/or CHW, network delivery system, and operational infrastructure including data exchange, workforce training and capacity building.
3. Support ECM, CS and/or CHW delivery process in accordance with DHCS service definitions, eligibility criteria, and reporting requirements.
4. Oversee the development and management of the ECM, CS, and/or CHW provider network including:
5. Serve as a knowledge and resource expert for ECM, CS and/or CHW provider network operations.
6. Establish and manage positive and productive working relationships with all public and community-based providers and vendors delivering services to members under ECM, CS, and/or CHW .
7. 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.
8. 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.
9. 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.
10. Schedule, conduct and report on regular site visits with each provider as required.
11. 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.
12. Establish and track ECM, CS, and/or CHW provider compliance with agreement scope of work, key operational objectives, and quality and performance metrics.
13. Support the Department Manager in generating reports and performing special projects.
14. Troubleshoot with providers to address issues related to submission of claims and encounter data for CHW services.
15. Understand and track applicable regulatory and reporting requirements.
16. Ensure accuracy and regulatory compliance for all materials or documents.
17. Attend off-site meetings or events as necessary.
18. 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.

1. Bachelor's degree in public health, social welfare or related field; or equivalent experience, training, or coursework. (R)
2. Minimum two years of progressively responsible and direct work experience working with the essential duties and responsibilities described above. (R)
3. Demonstrated experience leading/managing projects, initiatives, and/or leading or directing the work of others. (R)
4. Knowledgeable in the field of home and community-based services and community resource networks and particularly interest in working to address health disparities and addressing the needs of low-income communities. (R)
5. A deep understanding of SDOH that impact Santa Clara County and community members. (R)
6. Ability to think creatively and work strategically, to help develop and implement innovative solutions yielding measurable results to the organization. (R)
7. Ability to think creatively and strategically, gather and analyze data, organize and write reports, organize work efficiently. (R)
8. Ability to understand, interpret, and apply applicable rules and regulations, and establish and evaluate priorities. (R)
9. Advanced working knowledge and proficiency with Microsoft Suite applications, and the ability to operate all applicable software. (R)
10. 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)
11. Ability to effectively facilitate meetings and deliver information/presentations to management, regulators, or staff (R).
12. Ability to think and work effectively under pressure and accurately prioritize and complete tasks within established timeframes. (R)
13. Ability to take initiative and exercise good judgment when making decisions within the scope of the position. (R)
14. Ability to comply with all SCFHP policies and procedures. (R)
15. Ability to perform the job safely with respect to others, to property, and to individual safety. (R)
16. 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)
17. Knowledge of the community-based delivery system and managed care. (D)
18. Project Management Professional (PMP) certification (D)
19. Working knowledge of and the ability to efficiently operate all applicable computer software including computer applications such as Outlook, Word and Excel. (R)

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:

1. 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)
2. Lifting Requirements: regularly lift and carry files, notebooks, and office supplies that may weigh up to 5 pounds; (R)
3. 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)
4. Dexterity Requirements: regular use of hands, wrists, and finger movements; ability to perform repetitive motion (keyboard); writing (notetaking); ability to operate a computer keyboard and other office equipment (R)
5. Hearing/Talking Requirements: ability to hear normal speech, hear and talk to exchange information in person and on telephone; (R)
6. 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