Senior Clinician

2 days ago


Oakland, California, United States Blue Cross Blue Shield companies Full time
About the Role

Your Opportunity

The Behavioral Health Utilization Management team at Blue Shield of California is seeking a highly skilled Licensed Clinician, Senior to join our team. As a key member of our team, you will play a critical role in conducting clinical reviews of mental health and substance use authorization requests to ensure that our members receive the necessary care and support.

Key Responsibilities
  • Conduct prospective, concurrent, and retrospective utilization reviews and first-level determination approvals for members admitted to inpatient facilities using evidence-based guidelines, policies, and nationally recognized clinical criteria.
  • Gather clinical information and apply the appropriate clinical criteria, guidelines, policies, and procedures to render coverage determinations and recommendations along the continuum of care.
  • Prepare and present cases to a Medical Director for oversight and necessity determination.
  • Provide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies, and procedures.
  • Work with multidisciplinary teams to support members using an integrated team-based approach, including interdisciplinary team meetings and case consultations with a Medical Director and/or Licensed Manager.
  • Recognize members' rights to self-determination and autonomy, including the right to make informed choices that may not promote the best outcomes, as determined by the healthcare team.
  • Support the team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standards.
What We Offer

As a Licensed Clinician, Senior at Blue Shield of California, you will have the opportunity to work with a talented team of professionals who are passionate about delivering high-quality care to our members. We offer a dynamic and supportive work environment, competitive compensation and benefits, and opportunities for professional growth and development.



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