Rachel Lambert Email & Phone Number

Santa Barbara, Ca, Us

This role involves overseeing the operations and providing clinical leadership for Behavioral Health Services offered to CenCal Health members. It includes monitoring the quality of care provided by contracted providers, overseeing behavioral health-related activities such as access to mental health care, case management, utilization review, grievances, and quality management. The position also involves leading a team that offers behavioral health telephonic clinical triage, care coordination, and utilization management. Additionally, the role entails collaborating with the Medical Director(s) for Mental and Behavioral Health to establish clinical protocols for managing the behavioral health needs of CenCal Health members. The individual in this role will also work with clinical leadership in county behavioral health departments, contracted clinics, and other providers to address common clinical issues. Furthermore, when required, the individual will represent the Plan before governmental and advisory bodies.

Camarillo, Ca, Us

I now manage the planning, development, and implementation of the SABIRT, IPP, CalAIM, Behavioral Health Care Management, and Pediatric and Adult Complex Care Management strategies for the Health Services division of GCHP. To provide effective oversight and optimization of the CalAIM and Care management programs at GCHP, including enhanced care management and community support execution as well as growth, it is important to mention that I supervise teams. I also develop strong departmental strategies to implement new requirements for the seamless integration of new target populations and programs under CalAIM. Additionally, I develop and advance several important activities within the Health Services Department using a population health perspective, including new and existing CalAIM initiatives, practice improvement, and steps to enhance procedures as identified by Knox Keene and NCQA guidelines for CM.Key Achievements: Developed and implemented community support programs from beginning to finish, including rehabilitative care, housing transition guidance, housing sustaining services, housing deposits, medically customized meals, and short-term post-hospitalization accommodation. Designed and executed creative social determinants of health projects with a focus on homelessness, significant mental illness, substance abuse, engagement in the criminal system, and high-cost patients to enhance treatment for people. Incredibly helpful in network growth and supporting non-traditional providers by running a large-scale, all-encompassing incentive scheme. Consulted and collaborated with the Chief Medical Officer and Associate Chief Medical Officer on several strategic issues relating to CM initiatives. Supervised a highly skilled group of 40 registered nurses, clinical social workers, and support staff.

Camarillo, Ca, Us

Responsibilities:I oversaw a team of 37 individuals in this role, including three manager-level direct reports, LMFTs, LCSWs, MSNs, RNs, and non-clinical staff. I directed CM staff and activities, provided guidance for the Chief Medical Officer on program-related strategic issues, and oversaw performance reporting. To effectively advance CalAIM objectives, I was in charge of all major aspects of case management, care coordination, chronic illness management, care transitions, and other programs, including the development and implementation of new ones. In addition, I oversaw CM projects to support quality improvement and population health goals, such as focused care management for defined groups, grievance and appeals operations, and programs to close gaps.Key Achievements: To provide uniform clinical oversight for all providers of Enhanced Care Management (ECM) and Community Supports (CS), clinical case reviews, quality audits, and reporting were carried out every quarter. To help high-risk and high-need members obtain treatment and care, I successfully orchestrated the transfer of a pilot program to a new benefit through a health plan.

Camarillo, Ca, Us

Responsibilities:I headed a team of 16 workers in this capacity, including LCSWs, MSNs, RNs, and non-clinical staff. By producing reports in the EHR, I ensured the timely and effective delivery of care management services. Furthermore, I created and provided commission, neighborhood partners, and national conferences with precise data on care management strategies and performance. Additionally, I acted as the primary point of contact and health plan liaison for a number of neighborhood partners. By working with teams from Population Health, Health Education, Utilization Management, Quality Improvement, Grievances, and Appeals, I developed project plans for specific programs.Key Achievements: Developed and implemented a proactive care management program for new health plan members, providing outreach to those with risk factors and identifying requirements for assistance in navigating personal benefits; program regularly produced an ROI of roughly 23% fewer ER usage and 13% fewer inpatient stays. By conducting business with the highest level of honesty, cultivating trust, and establishing enduring credibility with both internal and external partners, services were expedited and care gaps for members were reduced. Created a new care management program design and implemented interdisciplinary care teams to increase organizational efficiency altogether.

Responsibilities:In this position, I oversaw a group of eight employees, among them MSW, MPH, and MSN. I devised, coordinated, and taught participants in all significant facets of the services offered in the community. I contributed to the entire NCQA certification audit preparation. I raised awareness of Alzheimer's, dementia, and Parkinson's disease and gave families and residents coaching. I formed and expanded crucial alliances with relevant groups to increase outreach, showcase program successes, and raise success rates by reducing duplication.Key Achievements: Supported case management team through NCQA accreditation and organized/coordinated care services to ensure help for the elderly population suffering from Alzheimer's, Dementia, Parkinson's, and traumatic brain injuries, as well as their caregivers. Developed and implemented several innovative policies and initiatives that significantly increased client independence.

Santa Barbara, Ca, Us

Key Contributions: Acted as the primary spokesperson for the TCRC in collaboration with organizations at the local, state, and provider levels. Used outstanding leadership and people management skills to oversee a team of 15 employees. Inter-departmental partnerships effectively dealt with any service problems for the people they served. Contributed significantly to the formulation and implementation of agency policies and important processes.

Key Contributions: Improved hiring, training, and recruiting of new employees; better personal and professional development of present employees. Supervised an 8-person MFT intern team that was in charge of effectively providing outreach, education, and crisis response. Managed federal and state budgets and created a client database on a computer for clinical clients.

 By upholding the highest standards of quality, we gave families excellent opportunities. evaluated and identified the unique requirements of each client, then developed effective, tailored behavior regimens in response. significantly influenced the creation and implementation of workshops for new programs and treatment plans.

Master Of Business Administration - Mba, Health/Health Care Administration/Management

Master Of Science (M.S.), Counseling Psychology

Bachelors Of Science, Psychology

Education record