Blue Shield of California
Senior Behavioral Health Utilization Management Clinician
Blue Shield of California, Washington, District of Columbia, us, 20022
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Senior Behavioral Health Utilization Management Clinician
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Blue Shield of California 1 day ago Be among the first 25 applicants Join to apply for the
Senior Behavioral Health Utilization Management Clinician
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Blue Shield of California Get AI-powered advice on this job and more exclusive features. The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business. The Behavioral Health Utilization Management Clinician, Senior, will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health and substance use authorization requests at various levels of care for medical necessity, coding accuracy, medical policy compliance and contract compliance. California license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) is required, In this role, you will: Perform prospective & concurrent utilization reviews and first level determination approvals for members admitted to facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as needed Gather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for medical director oversight and necessity determination Provide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteria Work with multidisciplinary teams to support members using an integrated team-based approach including Interdisciplinary Team Meetings and case consultations with Medical Director and/or Licensed Manager Recognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team Support team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standards Qualifications Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) required Advanced degree commensurate with field is preferred Requires at least five (5) years of prior experience in healthcare related field Three (3) years conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment required Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Blue Shield of California by 2x Get notified about new Behavioral Health Specialist jobs in
Washington, United States . Washington Licensed Behavioral Health Care Manager
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Senior Behavioral Health Utilization Management Clinician
role at
Blue Shield of California 1 day ago Be among the first 25 applicants Join to apply for the
Senior Behavioral Health Utilization Management Clinician
role at
Blue Shield of California Get AI-powered advice on this job and more exclusive features. The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business. The Behavioral Health Utilization Management Clinician, Senior, will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health and substance use authorization requests at various levels of care for medical necessity, coding accuracy, medical policy compliance and contract compliance. California license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) is required, In this role, you will: Perform prospective & concurrent utilization reviews and first level determination approvals for members admitted to facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as needed Gather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for medical director oversight and necessity determination Provide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteria Work with multidisciplinary teams to support members using an integrated team-based approach including Interdisciplinary Team Meetings and case consultations with Medical Director and/or Licensed Manager Recognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team Support team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standards Qualifications Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) required Advanced degree commensurate with field is preferred Requires at least five (5) years of prior experience in healthcare related field Three (3) years conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment required Seniority level
Seniority level Mid-Senior level Employment type
Employment type Full-time Job function
Job function Health Care Provider Industries Hospitals and Health Care Referrals increase your chances of interviewing at Blue Shield of California by 2x Get notified about new Behavioral Health Specialist jobs in
Washington, United States . Washington Licensed Behavioral Health Care Manager
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr