Senior Behavioral Health UM Clinician - Hybrid

Blue Shield of CA; Long Beach (CA); Hybrid; USD 110,000 - 140,000; Full time

Job summary

Blue Shield of California is seeking a Senior Behavioral Health Utilization Management Clinician to conduct clinical reviews of mental health and substance use requests, ensuring medical necessity and policy compliance across care levels.

This role emphasizes collaboration, analytical rigor, and strong communication, with hybrid-virtual work and opportunities to contribute to leadership development within BH UM.

Qualifications

• Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) required.
• RN requires an Associates degree or Masters degree in relevant field for non-RN licensure.
• 5 years of prior relevant experience in managed care environment or clinical setting.
• Strong understanding of Behavioral Health Utilization Management and criteria (MCG, etc.).
• Familiarity with medical terminology, psychiatric evaluations, and lab results.
• Proficient with Microsoft Excel, Outlook, Word, Power Point, and learning multiple systems/databases.
• Excellent analytical, communication, written, time management, and organizational skills.
• Strong interpersonal skills, positive attitude, initiative.
• Ability to identify problems and work toward resolution independently.

Responsibilities

• Conduct clinical review of mental health and substance use authorization requests.
• Assess medical necessity, coding accuracy, and policy/ contract compliance across levels of care.
• Collaborate with BH UM team and support leadership development.

Skills

Clinical review

Analytical skills

Communication skills

Time management

Problem solving

Education

Master's degree in related field

Associates or higher for RN pathway

Tools

Excel

Outlook

Word

PowerPoint

Job description

Blue Shield of California is seeking a Senior Behavioral Health Utilization Management Clinician to conduct clinical reviews of mental health and substance use requests, ensuring medical necessity and policy compliance across care levels.

This role emphasizes collaboration, analytical rigor, and strong communication, with hybrid-virtual work and opportunities to contribute to leadership development within BH UM.