Behavioral Health Utilization Management Clinician, Consultant (Lead)

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

Job summary

A leading healthcare company is seeking a Behavioral Health Utilization Management Consultant (Lead) to oversee clinical reviews and support clinicians. The ideal candidate will have extensive experience in behavioral health, strong analytical and communication skills, and a relevant California license. This role offers an opportunity to lead a team in a dynamic healthcare environment.

Qualifications

• At least seven years of experience in healthcare.
• Five years in Behavioral Health Utilization Management preferred.
• Experience in a lead role or equivalent leadership training.

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

Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD, or RN)

Advanced degree in 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 and 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 as they conduct 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 commensurate with the field is preferred
• At least seven (7) years of prior experience in a healthcare-related field
• Experience operating in a lead role or equivalent leadership training is preferred
• Five (5) years 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 apply and 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
• Proficient with Microsoft Excel, Outlook, Word, PowerPoint, and the ability to learn and utilize multiple systems/databases
• Excellent analytical, communication, written, time management, and organizational skills
• Outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiative
• Ability to identify problems and work towards resolution independently, seeking guidance as needed