Member Liaison Specialist, Behavioral Health / Job Req 570743685

PRINCIPLE RESPONSIBILITIES:

The Member Liaison Specialist (Behavioral Health), MLS, is responsible for the intake and triage services for telephonic (call center) or online (member portal), chat, behavioral health (BH), and autism spectrum disorder (ABA) related referrals and inquiries to all care coordination programs within AAH and external provider network. MLS will ensure members seeking assistance will have a pathway to care that is both timely and adequate to meet their behavioral health care needs. Member Liaison Specialist will excel at communicating with members, both internal and external partners ensuring that each referral is triaged to the most appropriate program, including a warm handoff.

The Member Liaison Specialist (Behavioral Health) position requires a basic understanding of mental health disorders to determine the appropriate level of care for Members and interface with Behavioral Health Team regarding appropriate BH and ASD member referrals.

The MLS may occasionally function as a Member Service Representative in high call volumes or staffing shortages.

Principle responsibilities include:

• Serves as an advocate to assist in coordinating the members identified psychosocial needs, utilizing community resources and support when appropriate.
• Collaborates and communicates with the member, conservators, authorized member representative(s), physicians/provider office staff, health networks, and other health care providers to support and accomplish goals identified.
• Ensures the privacy and security of PHI (Protected Health Information) as outlined in AAH’s policies and procedures relating to HIPAA compliance.
• Practice active engagement with callers and establish sufficient rapport to promote the caller’s collaboration in securing their safety.
• Triage/screening to assist members in securing behavioral health services.
• Meet the performance goals established for the position in efficiency, call quality, member satisfaction, first call resolution, punctuality, and attendance.
• Understand the Call Center Service Level agreements and work to ensure that they are met.
• Ensures documentation is accurate and in compliance with regulatory requirements and accreditation standards.
• Assess the needs of members seeking an assessment and ensure their referral to the service or resource that best addresses those BHT needs.
• Develops and maintains a network of current community resources and services where members can receive appropriate assistance.
• Maintain complete and accurate documentation of cases within our proprietary database.
• Using critical thinking and problem-solving skills, quickly resolve issues and identify resources to ensure a positive client experience and complete satisfaction
• Collaborate and communicate with management on issues and processes that impact Care Management and other organizational entities internally and externally.
• Assists member walk-ins in coordination with medical and behavioral health services care teams.
• Maintain documentation of member interactions within the Member Services Management System (HealthSuite/Qualitysuite).
• Other projects and duties as assigned.
• Responsible for managing incoming Behavioral Health (BH) requests through the BH call center phone queue and online (member portal).
• Coordinates member’s behavioral and social service needs both within and outside AAH to coordinate members’ care.
• Understands the importance of excellent customer service and timely processing of requests as it pertains to behavioral health and autism spectrum disorder.
• Follows Behavioral Health guidelines and protocols in coordinating with Behavioral Health Care Managers and the Behavioral Health Department for Triage and Referral for members with urgent or complex needs.
• Assists members in securing outpatient follow-up appointments in a manner synonymous with a warm handoff to support connection to ongoing care.
• De-escalation/resolution of behavioral health crisis calls.
• Provides member education on plan resources, eligibility, and services with a positive and professional approach.
• Initiates referrals to both internal care management departments and other government agencies.

ESSENTIAL FUNCTIONS OF THE JOB:

• Develop rapport, establish, and maintain effective interpersonal relationships with internal and external contacts.
• Communicate effectively, both verbally and in writing to a diverse population.
• Effectively utilize computer and appropriate software to produce correspondence, charts, spreadsheets, and other information applicable to the position.
• Work with appropriate departments to expedite the resolution of member concerns.
• Adhere to AAH policies/procedures (i.e., PHI/HIPAA).
• Remain knowledgeable of the available health plans and AAH’s benefit structure.
• Maintain accurate records of all member interactions and referrals.
• Develop creative/innovative approaches to challenges and opportunities.

PHYSICAL REQUIREMENTS:

The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

• Physical demands: While performing duties of job, employee is required to move about the organization. Employee must be able to sit for extended periods of time, as well as work at the computer for long periods. Employee is required to use hands and fingers, especially for typing on the computer and using the mouse. Must also be able to reach with hands and arms & must occasionally lift heavy office supply boxes. Employee must be able to speak and hear, particularly for regular communication on the phone.

• Work Environment: Must be able to focus and function in a high pace, moderate noise level work environment. Office temperatures are controlled and comfortable.

Number of Employees Supervised: 0

MINIMUM QUALIFICATIONS:

EDUCATION OR TRAINING EQUIVALENT TO:

• Customer service: call center experience preferred.
• Experience in working with children diagnosed with ASD or ABA services preferred.
• HMO, Medi-Cal/Medicare, and health services experience preferred.
• High school diploma or equivalent is required.
• Bachelor's degree in behavioral health or related field is preferred.
• Two years of experience in behavioral health, community services, or other social services setting are required.

MINIMUM YEARS OF ADDITIONAL RELATED EXPERIENCE:

• One year experience in Triage, Intake or Care Coordination

SPECIAL QUALIFICATIONS (SKILLS, ABILITIES, LICENSE):

• Knowledge of and experience with California Children’s Services (CCS) is a plus
• Experience working with people with complex health needs preferred.
• Experience triaging crisis calls from members and escalating as needed.
• Bi-cultural, bi-lingual language skills preferred (English/Spanish).
• Working knowledge and use of Pers-Centered language and principles a plus.
• High degree of patience. Ability to communicate and work effectively with a variety of providers and individuals
• Experience with Crisis Intervention Mental Health Services is strongly preferred.
• Knowledge of and experience with state and federal insurance programs a plus
• Telephone courtesy and a high degree of patience.
• Ability to work regularly scheduled shifts within the Alliance’s hours of operation including the training period, with scheduled lunches and breaks, flexibility to adjust daily schedules, and to work overtime and weekends as needed.
• Utilization Management, Case Management, Care Coordination, or Telephonic Case Management experience a plus
• Basic medical knowledge, including the ability to recognize medical and social risk factors, knowledge of chronic disease conditions, and common treatment options
• Working knowledge and use of Trauma-Informed and Harm Reduction language and principles a plus.
• Knowledge of Alameda County community resources, Medicare, Medi-Cal, and Managed Care.
• Experience with de-escalation techniques strongly preferred.

SALARY RANGE: $38.48-$57.72 PER HOUR

The Alliance is an equal opportunity employer and makes employment decisions on the basis of qualifications and merit. We strive to have the best qualified person in every job. Our policy prohibits unlawful discrimination based on race, color, creed, gender, religion, veteran status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, genetic characteristic, sexual orientation, gender identity or expression, or any other consideration made unlawful by federal, state, or local laws. M/F/Vets/Disabled.