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Senior Licensed Clinician

3 months ago

San Pedro, United States Blue Shield Of California Full time

Your Role

The Behavioral Health Utilization Management team is seeking a Senior Licensed Clinician to perform prospective, concurrent, and retrospective utilization reviews for members using evidenced-based guidelines and clinical criteria. The role involves conducting clinical review of mental health and substance use authorization requests, ensuring discharge planning, and developing member-centered documentation in compliance with standards and regulations.

Your Work

  • Conduct utilization reviews and approval determinations using evidence-based guidelines
  • Ensure appropriate discharge planning and prepare cases for medical director oversight
  • Develop member-centered documentation in compliance with standards
  • Provide information to facilities and providers regarding treatment resources and medical necessity criteria
  • Interact with Physician Advisors and participate in case consultations with the Licensed Manager

Your Knowledge and Experience

  • Current CA LCSW, LMFT, LPCC, or Licensed Psychologist licensure
  • At least 5 years of prior experience in healthcare
  • Proficient with MS Office and ability to learn and utilize multiple systems/databases
  • Excellent analytical, communication, time management, and organizational skills
  • Understanding of behavioral health utilization management and clinical criteria sets

Pay Range:

The pay range for this role is: $87,230.00 to $130,900.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location, and current employee salaries for similar roles.