Job DescriptionYour 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.
ResponsibilitiesYour 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, scheduled work, 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
- Representing Behavioral Health UM as a Subject Matter Expert in cross departmental meetings and process design
QualificationsYour Knowledge and Experience - Current, unrestricted CA LMFT, LCSW, LPCC, PhD/PsyD or RN license required
- Associates degree required for an RN license
- Master's degree in counseling required for LMFT, LCSW, LPCC
- Bachelor of Science in Nursing preferred
- Doctoral degree required for PhD or PsyD
- Requires advanced knowledge of job area usually obtained through advanced education combined with experience
- Requires at least seven (7) years of prior relevant experience
- Three (3) years of management experience gained as a team leader, supervisor or project/program manager
- Three (3) years conducting Utilization Management for a health plan preferred
- Understands Blue Shield of CA's mission and business plan
- Understands basic management approaches such as work scheduling, prioritizing, coaching and process execution, work organization, risk management and delegation
- Has functional expertise within the area of responsibility
- 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
HybridThis role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
Our Workplace Model We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:
- For most teams, this means coming into the office two days per week.
- Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
- For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
Physical Requirements:Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
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