Behavioral Health Utilization Management Clinician, Consultant (Lead)

Blue Shield of CA; Lodi (CA); On-site; USD 90,000 - 120,000; Full time

Job summary

A leading health insurance provider is seeking a Behavioral Health Utilization Management Consultant (Lead) to support clinicians and conduct clinical reviews for mental health and substance use authorization requests. This role requires extensive healthcare experience and specific licenses, offering a competitive salary and the opportunity to make a significant impact in the field.

Qualifications

• Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD, or RN with Behavioral Health experience) required.
• At least seven (7) years of healthcare-related experience required.
• Five (5) years of experience conducting Behavioral Health Utilization Management preferred.

Responsibilities

• Support clinicians with daily operations and provide coaching.
• Conduct clinical reviews of mental health and substance use authorization requests.
• Serve as the subject matter expert for the BH UM team.

Skills

Analytical skills

Communication

Organizational skills

Interpersonal skills

Education

Advanced degree in a relevant field

Tools

Microsoft Excel

Microsoft Outlook

Microsoft Word

Microsoft PowerPoint

Job description

Your Role

The Behavioral Health (BH) Utilization Management (UM) team performs prospective, concurrent, and retrospective utilization reviews, along with first-level determinations for members, using BSC evidence-based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The Behavioral Health Utilization Management, Consultant (Lead), reports to the Manager of Behavioral Health Utilization Management (BH UM). In this role, you will support clinicians with daily operations, provide coaching, and serve as the subject matter expert for the BH UM team, conducting clinical reviews of mental health and substance use authorization requests at various levels of care for medical necessity.

Your Knowledge and Experience

• Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD, or RN with Behavioral Health experience) required
• Advanced degree in a relevant field is preferred
• At least seven (7) years of healthcare-related experience required
• Leadership experience or training is preferred
• Five (5) years of experience conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment is preferred
• Deep knowledge of Behavioral Health Utilization Management, including the ability to interpret admission and continued stay clinical criteria against nonprofit association guidelines
• Familiarity with medical terminology, diagnostic terms, and treatment modalities, including the ability to comprehend psychiatric evaluations, clinical notes, and lab results
• Proficiency with Microsoft Excel, Outlook, Word, PowerPoint, and the ability to learn and use multiple systems/databases
• Excellent analytical, communication, written, time management, and organizational skills
• Outstanding interpersonal skills, positive attitude, and high initiative
• Ability to identify problems and work towards resolution independently, seeking guidance as needed