Manager, Behavioral Health Utilization Management

Your Role

The Behavioral Health Utilization Management (UM) team performs prior authorization and concurrent reviews for members by applying evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The Manager, Behavioral Health Utilization Management will report to the Sr. Manager, Behavioral Health Utilization Management. In this role you will be responsible for the day-to-day operations of the business unit and execution of departmental goals and objectives. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In this role, you will:

• Manage a team of licensed clinicians responsible for prior authorization and concurrent review

• Be responsible for the daily operations of the Behavioral Health Utilization Management team including staffing, work scheduled, assignments, efficient workflow, and performance

• Provide oversight of licensed clinicians to ensure appropriate application of clinical guidelines 

• Oversee caseload management and adherence to regulatory, accreditation and contractual requirements

• Monitor clinician workloads via daily performance monitoring reports

• Represent Behavioral Health UM as a Subject Matter Expert in cross departmental meetings and process design

Your Knowledge and Experience 

• Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) required; requires a bachelor's degree 
• College degree to include Master’s degree in counseling or related field or Bachelor of Science in Nursing required
• Requires at least seven (7) years of prior relevant experience 
• Requires three (3) years of management experience 
• Three (3) years conducting Utilization Management for a health plan preferred 
• Understands Blue Shield of CA's mission and business plan 
• Strong understanding of behavioral health utilization management including application of multiple standardized clinical criteria sets including but not limited to MCG guidelines, nonprofit association guidelines, and various Medicare guidelines