Clinician Sr (Behavioral Health) Case Management

  • CalOptima
  • 505 City Pkwy W, Orange, California
  • Mar 08, 2024
Full Time Human and Social Services Public Health

Job Description

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Clinician Sr (Behavioral Health) Case Management

Job Description
Department(s): Behavioral Health Integration
Reports to: Supervisor, Behavioral Health
FLSA status: Non-Exempt
Salary Grade: L - $77,000 - $127,094

Applications will be accepted on a continuous basis until a sufficient number of qualified applications have been received. The deadline for the first review of applications is on Tuesday, February 13, 2024 at 11:59 PM. Applicants are encouraged to apply early. Applicants that apply after the first review are not guaranteed to be considered for this recruitment. This recruitment may close at any time without notice after the first review date.

About CalOptima Health

Are you looking for a career that changes lives? As the single largest health plan in Orange County, CalOptima Health serves one in three residents with health insurance programs for low-income children, adults, seniors and people with disabilities. Our 1,500 employees are valued for their individual perspectives and contributions and benefit from flexible work schedules, recognition and opportunities to grow. If you're looking for a rewarding career supporting a meaningful mission, along with generous benefits and recognition, consider joining us at CalOptima Health!

About the Position

The Clinician Sr (Behavioral Health) Case Management is an advanced specialty collaborative practice responsible for providing case management services for CalOptima Health's members. The Clinician Sr will facilitate communication and coordination among participants of the health care team and CalOptima Health's members to ensure that services are provided, which promote quality cost-effective outcomes. The incumbent will provide case management intervention on behalf of members who have a behavioral health condition and may have co-occurring medical needs. The incumbent will answer with behavioral health clinical appropriateness, quality and cost effectiveness of proposed behavioral health services in accordance with established criteria. The Clinician Sr will provide back-up to the call center and will be responsible for completing telephonic behavioral health screenings and determining member behavioral health level of care needs, which includes telephonic behavioral health crisis intervention, higher level of care referrals and coordination of care between physical and behavioral health. The incumbent coordinates activities between CalOptima Health staff, contracted providers and health networks by providing guidance and support when appropriate for CalOptima Health Medi-Cal and OneCare members.

Duties & Responsibilities:
  • Participates in a mission driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability.
  • Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
  • Reviews and evaluates proposed services utilizing established policies and procedures.
  • Analyzes all requests with the objective of monitoring utilization of services, which includes medical appropriateness and identifies potentially high-cost complex cases for high level case management intervention.
  • For short-term cases, conducts a thorough and objective assessment of the member's status including psychosocial and environmental and gathers all information pertinent to the case.
  • Assesses member's status and progress. If progress is static or regressive, determines reason and proactively encourages appropriate referrals to higher level of case management or makes appropriate adjustments in the care plan, providers and/or services to promote better outcomes.
  • Establishes methods of communication and collaboration with other team members, physicians, community agencies and administrators.
  • Prepares and maintains appropriate documentation of patient care and progress within the care plan.
  • Acts as an advocate in the client's best interest for necessary funding, treatment alternatives, timelines and coordination of care.
  • Provides frequent evaluations of progress and goals.
  • Works collaboratively with staff members from various disciplines involved in patient care with an emphasis on interpreting and problem-solving complex cases.
  • Documents case notes and rationale for all decisions.
  • Completes telephonic behavioral health assessments and triages for members with behavioral health needs.
  • Coordinates referrals to the County Mental Health Plan for members who may need additional mental health and/or behavioral health case management support.
  • Coordinates and collaborates between behavioral health providers, health networks and CalOptima Health departments for problem resolution and service integration, including providing consultations on resolving complex case management issues and serving on the treatment team.
  • Participates in bi-weekly clinical team meetings.
  • Supports members in navigating the behavioral health systems of care.
  • Builds and maintains relationships with the County Mental Health Plan, providers, health networks, community-based organizations and other key stakeholders.
  • Educates CalOptima Health staff, health networks, providers and members on behavioral health issues and available resources.
  • Completes other projects and duties as assigned.


Experience & Education
  • Master's degree in social work, clinical psychology, marriage and family therapy or related field of study is required.
  • Current unrestricted California license required: Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC) or Licensed Psychologist (PhD, PsyD).
  • 3 years of related experience, e.g., clinician experience, required.
  • An equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above is also qualifying.


Preferred Qualifications
  • Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Farsi, Chinese, Korean, Spanish, Vietnamese).
  • 2 years of BH case management experience.
  • 1 year of call center experience.


Physical Demands and Work Environment

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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Physical demands: 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 be able to talk and hear, particularly for regular communication on the phone. Employee may at times be required to deal with significant time pressures if required to work on projects that have timeframes attached.


  • Work Environment: Employee will have one-on-one contact with other employees in a quiet environment where hearing and listening is paramount. Employee is expected to use diplomacy and problem-solving skills to procure data and information from other sources, as well as handle incoming public inquiries. Office environment with controlled office temperatures.


About our Benefits & Wellness options:

At CalOptima Health, we know that a healthy and happy workforce is a thriving workforce, which is why we offer a comprehensive benefits package, including participation in the California Public Employees Retirement System (CalPERS), low-cost medical/vision/dental insurance options, and paid time off. To support quality work-life balance, we allow flexible scheduling during core business hours, telework options for some positions, work schedules that allow every other Friday off (9/80 schedule), and a wellness program featuring diverse activities. Additionally, CalOptima Health contributes 4% of pensionable earnings to a 401(a) retirement program with no required employee contribution. Employees also have access to 457(b) retirement plans with pre/post-tax contribution options.

CalOptima Health is committed to attracting, hiring, and retaining a diverse staff, where we will honor your unique experiences, identity, and perspectives. Our organization strives to create and maintain a workplace environment that is inclusive, equitable and welcoming so we can truly be Better Together.

CalOptima Health is an equal employment opportunity employer and makes all employment decisions on the basis of merit. CalOptima Health wants to have qualified employees in every job position. CalOptima Health prohibits unlawful discrimination against any employee, or applicant for employment, based on race, religion/religious creed, color, national origin, ancestry, mental or physical disability, medical condition, genetic information, marital status, sex, sex stereotype, gender, gender identity, gender expression, transitioning status, age, sexual orientation, immigration status, military status as a disabled veteran, or veteran of the Vietnam era, or any other consideration made unlawful by federal, state, or local laws. CalOptima Health also prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has, or is perceived as having, any of those characteristics.

If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability.


Job Location: Orange, California
Position Type:

To apply, visit https://jobs.silkroad.com/CalOptima/Careers/jobs/4523







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Job Address

505 City Pkwy W, Orange, California 92868 United States View Map