Position Summary:

Under the direct supervision of the HCBA Waiver Manager, the HCBA Waiver Program Supervisor is responsible for all aspects of planning, development and supervision of the Home and Community Based Alternatives (HCBA) Medi-Cal Waiver enrollment process, to increase enrollment and maximize utilization of HCBA Waiver services within the community.

The HCBA Waiver Program Supervisor is responsible for supervising and assisting with all initial application screens, assigning and coordinating assessments for applicants to the HCBA Waiver program, and supervising the activities of Enrollment Specialists the application process. Additionally, this position works closely with the community and multiple community agencies to disseminate HCBA program and services information, including, but not limited to: designing marketing materials, creating presentations, and assisting with referrals to our program from other agencies.

The HCBA Waiver Program Supervisor directly oversees day-to-day operations, including but not limited to: employee performance reviews, reporting, process improvement, quality monitoring, and change management. Cultivates and maintains communication between HCBA Waiver Team and DHCS, SYH department, San Diego County, Imperial County, as well as other relevant community partners.

Essential Functions of the Job:

• Leads, coordinates and supervises the HCBA Waiver Enrollment team including monitoring and completing employee performance evaluations and disciplinary action (as needed).
• Assist HCBA Waiver Enrollment Team (Enrollment Team: enrollment specialist and CMT) to conduct HCBA Waiver phone eligibility screenings, initial screenings and assigns Care Management Teams to conduct assessments in the home of potential participants. Provides education and enrollment assistance to enrollment team to determine participant needs and eligibility for enrollment. 

• Responsible for the overall operation of the HCBA Waiver Program, including implementation of all policies, quality and production metrics, enhanced care management activities while in collaboration with community resources to ensure continuity of care.
• Coordinate all marketing and enrollment activities, including coordination with HCBA Waiver staff and other departments who may come into contact with HCBA Waiver eligible participants. Participates in marketing activities in conjunction with and as assigned by the HCBA Waiver Manager and/or Director of Patient Engagement.
• Act as liaison and one of the primary contact persons for enrollment and collaboration with DHCS, other Waiver Agencies, governmental entities, providers and others.
• Provides expertise on treatment adjudication request process, claim processes and HCBA Waiver contract, and acts as liaison with DHCS and providers on behalf of HCBA Waiver Program
• Works closely with the HCBA Waiver Manager to develop HCBA marketing materials. Provides resources to interested families, potential participants, community, partners, and providers.
• Develop and maintain multiple reports to assess and analyze enrollment activities for the purpose of maximizing enrollment, as well track and maintain report for the global HCBA Waiver case load (Transfer, disenrollment and case load distribution); maintains accurate records of critical incidents and case management outcomes for reporting and analysis.
• Prepares and submits statistical and/or productivity reports daily, weekly, and/or monthly by pre-determined deadlines and as required. Performs quality assurance and continuous quality improvement activities for the department.
• In collaboration with HCBA Waiver Manager, develop and monitor project timelines and budgets to ensure that projects are completed on time and within budget constraints.
• Designing and administering training programs for the different positions in the HCBA Waiver program, providing expertise in development design, identifying training needs and providing recommendation on programs and activities.
• Assign trainers and educators to specific training programs, provide them with the necessary training, and supervise their activities to ensure complete implementation of all learning initiatives.
• Collects and enters data in internal case log. Generates and submits Monthly and Quarterly Performance Reports as assigned by the HCBA Waiver Manager, to the State of California, Department of Health Care Services.
• Ensures a positive experience for potential enrollees, candidates, and their “Authorized Representatives”. Provides responsive, high-quality service to patients and others who interact with the HCBA Waiver and enrollment team. Provides accurate, complete and up to date information in a courteous, efficient and timely manner.
• Ensures compliance with all applicable CMS (Centers for Medicare & Medicaid Services) and California Department of Health Care Services (DHCS) and San Ysidro Health policies, rules, and regulations.
• Ensure compliance with documentation and maintains records.
• Assists with developing policies, procedures, and standards for department activities.
• Communicates job expectations with employees to achieve results. Provides performance supervision through coaching, counseling, and additional resources.
• Responsible for the direct supervision of Administrative Team (Referrals Coordinator(s), Administrative Assistant(s), Enrollment Specialist(s) and others) and MSWs/BSWs utilizing principles and techniques of supervision relating to training, direction, and evaluation of staff.
• Responsible for hiring, training, supervising, and evaluating assigned staff and daily activities.

Additional Duties and Responsibilities:

• Works independently and as an effective member of the team.
• Manage projects and their respective activities, timelines and issues.
• Able to adjust marketing and enrollment strategies as necessary based on data analysis.
• Establish and maintain effective interpersonal relationships with all levels of staff, other internal departments, outside agencies, providers, the general public and all referral sources.
• Complies with all department, organization and government policies & procedures.
• Attends meetings and training courses as required.
• Leads weekly staff meetings, participates on required local trainings, and out-of-town staff development opportunities when available.
• Adheres to and models SY Health’s core values and behaviors of Excellence, Empowerment, Integrity and Respect.
• Adheres to SY Health and HCBA Waiver attendance and punctuality policies and practices.
• Performs other duties as assigned.
• Adheres and ensures compliance with DHCS and SY Health rules and regulations.

Job Requirements:

Education Required:

Bachelor’s degree in healthcare, social work, public health, or a related field.

Certifications/Licenses Required: 

CA driver’s license with appropriate insurance coverage.

Experience and Required Skills: 

Minimum of 2 years of experience in a healthcare administration setting, with knowledge of:

• Referral and/or nursing billing authorization.
• Health care programs, including Medi-Cal eligibility requirements and regulatory guidelines.
• Program management principles and practices in healthcare or social services.
• Community-based healthcare programs, such as EPSDT (Early and Periodic Screening, Diagnostic, and Treatment), IHSS (In-Home Supportive Services), or WPCS (Waiver Personal Care Services).
• Medical terminology.
• Computer proficiency (Microsoft Office programs).
• Ability to multitask.

Verbal and Written Skills Required to Perform the Job:

Good verbal and written communication skills.

Equipment Used:

Computer, fax, additional software as required.

Working Conditions and Physical Requirements:

Prolonged sitting position, walking, constant telephone communication.  The standard schedule is Monday through Friday 8am to 5pm with flexibility for weekend/evening outreach events, as needed sporadically throughout the year. Driving and travel may be required in San Diego and Imperial counties.   

Universal Requirements:

Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs.