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 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

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.