Managed Care Outreach Specialist

Pacific Clinics; San Jose (CA); On-site; USD 3,923,000 - 4,824,000; Full time

Benefits offered by this job

Benefits eligibility day one

401K employer match up to 4%

Competitive time off

License differential 8% for LMFT/LCSW/

Bilingual differential up to 7.5%

Job summary

Pacific Clinics seeks an organized administrative professional to support managed-care programs, referrals, and billing processes. The role engages with clinical and finance teams to maintain program integrity and compliance.

The candidate will handle documentation, staff assignments, and enrollment communications, ensuring timely processing and accurate data in a fast-paced healthcare setting.

Qualifications

• High School Diploma or GED and two years of related experience, or equivalent combination of education and experience.
• Six months of experience in an administrative position in the Mental Health field.
• One year experience in an administrative position in the Mental Health field where data management and visualization tasks were involved.
• Must pass DOJ, FBI, and CAIC background clearance.

Responsibilities

• Provides administrative support to ensure programs meet customer, referral, payor, and staff needs.
• Assists with internal process improvements to ensure accountability for fiscal and administrative operations.
• Review TEL List and assign staff to clients in HHE and HHP.
• Deactivate excluded referrals and communicate deactivations to enrollees per process.
• Monitor Medi-Cal status and coordinate with clinical staff and Billing.

Skills

Excel proficiency

Administrative support

Data management

Education

High School Diploma or GED

Job description

• The initial compensation for this position ranges from $28.48 - $35.02 Per Hour, depending on experience, location and internal equity considerations

Overview

Compensation We Offer

• The initial compensation for this position ranges from $28.48 - $35.02 Per Hour, depending on experience, location and internal equity considerations

Possible Additional Compensation (may Vary Based On Position Eligibility)

• 8% License Differential for LMFT, LCSW, LPCC, PsyD. and select Peer Certifications
• Possible Bilingual Differentials: Up to 7.5% for qualifying direct-service roles; up to $80.00/month flat fee for qualifying non-direct service roles.

Benefits We Offer

• Benefits Eligibility starts on day ONE
• We provide a robust benefits package which includes medical, dental, vision, See our Benefits Page HERE.
• 401K Employer Match up to 4%
• Competitive Time Off Plans

Must meet eligibility requirements based on employment status

Pay Range

$28.48 - $35.02

Job Summary

Reports to the CPM or Program Administrator and support them in administration functions of the program. This position plays a critical role engaging potential customers in managed-care and similar programs (e.g., CCBHC)

Responsibilities

• Provides administrative support functions and tasks to ensure programs meet the customer, referral, payor, and staff support needs required to meet agency and contract expectations.
• Assists with the implementation of internal process that ensures the accountability for various fiscal and administrative operations.
• Review TEL List.
• Assign staff to clients in HHE and HHP.
• Deactive excluded referrals.
• Communicate deactivated enrollees via approved business processes.
• On-going review of medi-cal status and communicate to clinical staff and Billing.
• Serves as liaison for shared services; coordinates with other departments to meet various reporting and compliance needs.
• Manage authorizations (i.e., initial, renewal) with payors; implement processes with program managers and client services to prevent lapse of authorizations.
• Consults with finance department and program managers/directors about claims and billing issues and concerns.
• Assists with program audits, and customer contact to support clinical program (e.g., intake, discharge).
• Support regional QA for CQI activities and compliance.
• Practice self-care, remain aware that others may be contending with stress, and treat other with grace.
• Performs other responsibilities, as assigned, to support specific department/business needs.

Qualifications

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform essential job functions. All employees are responsible for keeping job requirements up to date. This can include but is not limited to certifications, licensure, and maintaining a clear criminal record.
• High School Diploma or GED and two (2) years of related experience, or equivalent combination of education and experience (two years of relevant experience equals one year of education) to include:
• Six (6) months of experience in an administrative position in the Mental Health field.
• One (1) year experience in an administrative position in the Mental Health field wheredata management and visualization tasks were involved.
• Must pass Department of Justice (DOJ), Federal Bureau of Investigations (FBI), and Child Abuse Index Check (CAIC) background clearance.

Job Competencies

• Contributes to Team Performance
• Manages Multiple Priorities Focus
• Business Acumen
• Intermediate to advanced excel
• Highly organized and detailed oriented
• Flexible & adaptable
• Analytical-ability to analyze detail to inform actions

Physical Requirements

The work environment conditions as described below are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee may be required to use hands to handle or feel objects, tools or controls; reach with hands and arms; and taste or smell. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. Driving Required May have unsupervised contact with children. Requires full background check and TB Exam. We are an Equal Opportunity Employer, which includes providing reasonable accommodations for individuals with a disability. We will consider for employment, qualified Applicants with Criminal Histories in a manner consistent with ordinance 184652 Sec.189.04 (a) and San Francisco Police Code, Article 49. Section 4905.