Manager, Program Management Clinical

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, Program Management Clinical will report to the Sr. Manager, Program Management Clinical. 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
• Requires at least seven (7) years of prior relevant experience
• Requires three (3) years of management experience
• Requires three (3) years conducting Utilization Management for a health plan
• 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