Licensed Clinician, Senior
4 weeks ago
Your Role
The Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business. The Licensed Clinician, Senior, will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health and substance use authorization requests at various levels of care for medical necessity, coding accuracy, medical policy compliance and contract compliance.
Your Work
In this role, you will:
- Perform prospective, concurrent and retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as needed
- Ensure discharge (DC) planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for medical director oversight and necessity determination
- Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards and identify potential quality of care issues, service or treatment delays and intervenes or as clinically appropriate
- Provide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteria
- Interact with Physician Advisors to discuss clinical questions and concerns regarding specific cases
- Actively participate in Interdisciplinary Team Meetings and case consultations with Licensed Manager
- Recognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare team
- Support team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standards
Your Knowledge and Experience
- Requires a current CA LCSW, LMFT, LPCC, or Licensed psychologist
- Requires at least 5 years of prior experience in healthcare related field
- Proficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databases
- Excellent analytical, communication skills, written skills, time management, and organizational skills
- Possess excellent interpersonal, organizational, and communication skills, positive attitude, and high level of initiative
- Requires understanding of behavioral health utilization management including application of multiple standardized clinical criteria sets including but not limited to MCG guidelines, nonprofit association guidelines, and various Medicare guidelines
- Ability to identify problems and works towards problem resolution independently, seeking guidance as needed
Pay Range:
The pay range for this role is: $ 87230.00 to $ 130900.00 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 (California, Bay area, or outside California), and current employee salaries for similar roles.
-
Licensed Clinician
2 months ago
Union City, United States Senior Care Therapy Full timeJob DescriptionJob DescriptionLicensed Mental Health Counselor LMHC, Licensed Marriage and Family Therapist LMFTWhat We Offer:No Admin Tasks! No cancellations! No no-shows! Flexible Daytime Hours We offer our clinicians with the support and resources they need to succeed! 401(k) Plan for FT or PT employees Full Time offers Excellent Health, Vision, and...
-
Licensed Clinician
18 hours ago
Atlantic City, United States Senior Care Therapy Full timeJob Description Licensed Mental Health Counselor LMHC, Licensed Marriage and Family Therapist LMFT What We Offer: No Admin Tasks! No cancellations! No no-shows! Flexible Daytime Hours We offer our clinicians with the support and resources they need to succeed! 401(k) Plan for FT or PT employees Full Time offers Excellent Health, Vision, and...
-
Licensed Clinician
2 weeks ago
Union City, United States Senior Care Therapy Full timeJob DescriptionLicensed Mental Health Counselor LMHC, Licensed Marriage and Family Therapist LMFT What We Offer: No Admin Tasks! No cancellations! No no-shows! Flexible Daytime Hours We offer our clinicians with the support and resources they need to succeed! 401(k) Plan for FT or PT employees Full Time offers Excellent Health, Vision, and...
-
Licensed Clinician
4 days ago
Union City, United States Senior Care Therapy Full timeJob DescriptionLicensed Mental Health Counselor LMHC, Licensed Marriage and Family Therapist LMFT What We Offer: No Admin Tasks! No cancellations! No no-shows! Flexible Daytime Hours We offer our clinicians with the support and resources they need to succeed! 401(k) Plan for FT or PT employees Full Time offers Excellent Health, Vision, and...
-
Licensed Clinician
1 day ago
Atlantic City, United States Senior Care Therapy Full timeLicensed Mental Health Counselor LMHC, Licensed Marriage and Family Therapist LMFT What We Offer: No Admin Tasks! No cancellations! No no-shows! Flexible Daytime Hours We offer our clinicians with the support and resources they need to succeed! 401(k) Plan for FT or PT employees Full Time offers Excellent Health, Vision, and Dental...
-
Licensed Clinician, Senior
7 days ago
Harbor City, United States Blue Shield Of California Full timeYour Role The Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business. The Licensed Clinician, Senior, will report to the...
-
Senior Manager, Financial Planning
3 weeks ago
California, United States Organigram Licensed Medical Marijuana Full timeWe are currently seeking candidates for the position of Senior Manager, Financial Planning & Analysis. Reporting to the Vice President of FP&A, the Senior Manager, Financial Planning & Analysis (FP&A), will play a pivotal role in establishing the company’s short and long-term corporate objectives, with a particular focus on leading the annual planning and...
-
Senior Behavioral Health Clinician
4 weeks ago
Iowa City, United States University of Iowa Full timeThe Office of Student Affairs and Curriculum (OSAC) is seeking a Senior Behavioral Health Clinician to address psychological needs of medical and physician assistant students through individual, group, and/or couples counseling. Provide outreach and Behavioral Health, Clinician, Behavioral, Mental Health, Health, Clinical, Healthcare
-
Senior Clinician
2 weeks ago
Iowa City, United States Covenant Family Solutions Full timeJob DescriptionJob DescriptionReady to take your leadership to the next level? Covenant Family Solutions is on the lookout for a dynamic Senior Clinician to join our team!🌟 Your Impact:Lead and inspire a dedicated team of Nurse Practitioners, Nursing Assistants, Licensed Mental Healthcare Providers, and Administrative Assistants.Manage your own client...
-
Senior Clinician
1 week ago
Iowa City, United States COVENANT FAMILY SOLUTIONS, LLC Full timeReady to take your leadership to the next level? Covenant Family Solutions is on the lookout for a dynamic Senior Clinician to join our team! 🌟 Your Impact: Lead and inspire a dedicated team of Nurse Practitioners, Nursing Assistants, Licensed Mental Healthcare Providers, and Administrative Assistants. Manage your own client caseload while ensuring a...
-
Senior Clinician
1 week ago
Iowa City, United States COVENANT FAMILY SOLUTIONS, LLC Full timeReady to take your leadership to the next level? Covenant Family Solutions is on the lookout for a dynamic Senior Clinician to join our team! ???? Your Impact: Lead and inspire a dedicated team of Nurse Practitioners, Nursing Assistants, Licensed Mental Healthcare Providers, and Administrative Assistants. Manage your own client caseload while ensuring a...
-
Senior Clinician
2 months ago
Iowa City, United States Covenant Family Solutions Full timeJob DescriptionJob DescriptionReady to take your leadership to the next level? Covenant Family Solutions is on the lookout for a dynamic Senior Clinician to join our team!🌟 Your Impact:Lead and inspire a dedicated team of Nurse Practitioners, Nursing Assistants, Licensed Mental Healthcare Providers, and Administrative Assistants.Manage your own client...
-
Licensed Clinical Social Worker, LCSW
3 weeks ago
Jersey City, United States Senior Care Therapy Full timeJob DescriptionLicensed Clinical Social Worker LCSW What We Offer: No Admin Tasks! No cancellations! No no-shows! Flexible Daytime Hours We offer our clinicians with the support and resources they need to succeed! 401(k) Plan for FT or PT employees Full Time offers Excellent Health, Vision, and Dental Insurance Benefits Full Time...
-
Licensed Clinical Social Worker, LCSW
3 weeks ago
Jersey City, United States Senior Care Therapy Full timeJob DescriptionJob DescriptionLicensed Clinical Social Worker LCSWWhat We Offer:No Admin Tasks! No cancellations! No no-shows! Flexible Daytime Hours We offer our clinicians with the support and resources they need to succeed! 401(k) Plan for FT or PT employees Full Time offers Excellent Health, Vision, and Dental Insurance Benefits Full Time offers...
-
Licensed Clinician
1 month ago
Jersey City, United States CarePoint Health Full timeAbout Us: CarePoint Health is one of New Jerseys leading health care systems comprised of three long-standing and highly-regarded hospitals Christ Hospital in Jersey City, Hoboken University Medical Center and Bayonne Medical Center. CarePoint united three area hospitals to provide 360-degree-coordinated care by integrating the medical facilities and...
-
Licensed Clinician
2 months ago
Jersey City, United States CarePoint Health System Full timeAbout Us CarePoint Health is one of New Jersey’s leading health care systems comprised of three long-standing and highly-regarded hospitals – Christ Hospital in Jersey City, Hoboken University Medical Center and Bayonne Medical Center. CarePoint united three area hospitals to provide 360-degree-coordinated care by integrating the medical...
-
Licensed Clinician
2 months ago
Jersey City, United States CarePoint Health Full timeAbout Us CarePoint Health is one of New Jersey’s leading health care systems comprised of three long-standing and highly-regarded hospitals – Christ Hospital in Jersey City, Hoboken University Medical Center and Bayonne Medical Center. CarePoint united three area hospitals to provide 360-degree-coordinated care by integrating the medical facilities and...
-
Licensed Mental Health Clinician
2 months ago
Kansas City, United States Centurion Health Full time: EARN A $5,000 BONUS FOR JOINING OUR TEAM FULL-TIME! Pay range from $65k $86k, based on years of experience and license. Overview: Centurion is proud to be the provider ofcomprehensive healthcare services to the Kansas Department of Corrections. We are currently seeking a full-time Licensed Mental Health Clinician to join our team at Lansing...
-
City of Industry, United States Blue Shield of California Full timeYour Role The Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business. The Licensed Clinician, Senior, will report to the...
-
Remote Licensed Psychiatrist
2 months ago
California City, United States Headway - Design & Development Full timeRemote Licensed Psychiatrist Wage: Between $148-$232 an hour Are you a licensed Psychiatrist looking to launch a private practice, or grow your existing practice? Headway can help you earn more through insurance! Headway supports thousands of mental health clinicians across the United States in our mission to rewire the mental healthcare system for access...