Senior Behavioral Health Utilization Review Clinician

Blue Shield of CA; Redding (CA); Hybrid; USD 110,000 - 150,000; Full time

Job summary

Blue Shield of CA is seeking a Behavioral Health Utilization Management Clinician, Senior, to conduct clinical reviews of mental health and substance use authorization requests across levels of care. This role supports medical necessity, coding accuracy, and policy compliance using established guidelines.

You will join a Hybrid Virtual Work model, with occasional office visits based on business needs. A CA license (LCSW/LMFT/LPCC/PhD-PsyD or an RN with BH experience) and 5 years of relevant

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 or clinical setting
• Strong understanding of Behavioral Health Utilization Management including admission/continued stay criteria
• Familiarity with medical terminology and psychiatric evaluations
• Proficient with MS Excel, Outlook, Word, PowerPoint and multiple systems/databases
• Excellent analytical, communication and time management skills
• Outstanding interpersonal and initiative-driven attitude

Responsibilities

• Conduct clinical review of mental health and substance use authorization requests at various levels of care
• Assess medical necessity, coding accuracy, and policy/contract compliance
• Apply standardized clinical criteria (e.g., MCG guidelines) to determinations
• Collaborate with teams for high-quality review decisions
• Maintain strong documentation and data tracking across systems

Skills

CA License

Clinical Experience

Utilization Management

Analytical Skills

Microsoft Office

Communication Skills

Time Management

Education

Associates or Masters degree

Tools

Excel

Outlook

Word

PowerPoint

Job description

Blue Shield of CA is seeking a Behavioral Health Utilization Management Clinician, Senior, to conduct clinical reviews of mental health and substance use authorization requests across levels of care. This role supports medical necessity, coding accuracy, and policy compliance using established guidelines.

You will join a Hybrid Virtual Work model, with occasional office visits based on business needs. A CA license (LCSW/LMFT/LPCC/PhD-PsyD or an RN with BH experience) and 5 years of relevant