What are the responsibilities and job description for the Sr. Manager, Program Management Clinical position at Blue Shield of CA?
Your Role
The Behavioral Health Utilization Management (UM) team performs prior authorization and concurrent reviews by apply evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The Sr. Manager, Program Management Clinical will report to the Director, Behavioral Health Utilization Management. In this role you will be responsible for managing all aspects of day-to-day operations of the Behavioral Health UM program, including adherence to regulatory compliance and direct oversight of performance quality. 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 (ten) 10 years of prior relevant experience
- Requires (four) 4 years of management experience which includes the supervision of clinical staff
- Three (3) years conducting Utilization Management for a health 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.
