Senior Clinician
2 days ago
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.
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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Senior Licensed Clinician
13 hours ago
Oakland, California, United States Blue Shield Of California Full timeJob Title: Senior Licensed ClinicianBlue Shield of California is seeking a highly skilled Senior Licensed Clinician to join our Behavioral Health Utilization Management team.About the RoleThe Senior Licensed Clinician will be responsible for conducting clinical reviews of mental health and substance use authorization requests at various levels of care for...
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Senior Licensed Clinician
2 weeks ago
Oakland, California, United States Blue Shield of California Full timeAbout the RoleThe Behavioral Health Utilization Management team at Blue Shield of California performs prospective, concurrent, and retrospective utilization reviews and first-level determination approvals for members using evidence-based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business.The Senior Licensed...
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Licensed Clinician, Senior
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Senior Licensed Clinician
2 days ago
Oakland, California, United States Blue Shield Of California Full timeYour RoleThe Behavioral Health Utilization Management team at Blue Shield of California performs prospective, concurrent, and retrospective utilization reviews and first-level determination approvals for members using evidence-based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business.Your...
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Licensed Clinician, Senior
3 weeks ago
Oakland, United States Blue Shield of California Full timeThe Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using Blue Shield of California (BSC) evidenced based guidelines, policies, and Behavioral Health, Clinician, Management, Licensed, Behavioral, Senior, Insurance, Healthcare
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1 week ago
Oakland, United States Blue Shield Of California Full timeThe Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using Blue Shield of California (BSC) evidenced based guidelines, policies, and Behavioral Health, Clinician, Management, Licensed, Behavioral, Senior, Insurance, Healthcare
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Oakland, United States Blue Cross Blue Shield companies Full timeYour Role The Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using Blue Shield of California (BSC) evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The Licensed Clinician,...
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Case Management
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Oakland, United States Blue Shield of California Full timeYour Role Reporting to the Senior Manager, Case Management - Behavioral Health, the Case Management – Clinician, Senior (Behavioral Health Care Manager) helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and program. The Case Management – Clinician, Senior will offer support...
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Case Management
4 weeks ago
Oakland, United States Blue Shield of California Full timeYour Role Reporting to the Senior Manager, Case Management - Behavioral Health, the Case Management – Clinician, Senior (Behavioral Health Care Manager) helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and program. The Case Management – Clinician, Senior will offer support...
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Case Management
4 weeks ago
Oakland, United States Blue Shield of California Full timeYour Role Reporting to the Senior Manager, Case Management - Behavioral Health, the Case Management – Clinician, Senior (Behavioral Health Care Manager) helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and program. The Case Management – Clinician, Senior will offer support...
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Case Management
3 weeks ago
Oakland, United States Blue Shield of California Full timeYour RoleReporting to the Senior Manager, Case Management - Behavioral Health, the Case Management – Clinician, Senior (Behavioral Health Care Manager) helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and program. The Case Management – Clinician, Senior will offer support...
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Case Management
4 weeks ago
Oakland, United States Blue Shield of California Full timeYour Role Reporting to the Senior Manager, Case Management - Behavioral Health, the Case Management – Clinician, Senior (Behavioral Health Care Manager) helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and program. The Case Management – Clinician, Senior will offer support...
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Case Management
4 weeks ago
Oakland, United States Blue Shield of California Full timeYour Role Reporting to the Senior Manager, Case Management - Behavioral Health, the Case Management – Clinician, Senior (Behavioral Health Care Manager) helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and program. The Case Management – Clinician, Senior will offer support...
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Case Management
3 weeks ago
Oakland, United States Blue Shield of California Full timeYour Role Reporting to the Senior Manager, Case Management - Behavioral Health, the Case Management – Clinician, Senior (Behavioral Health Care Manager) helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and program. The Case Management – Clinician, Senior will offer support...
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Case Management
3 weeks ago
Oakland, United States Blue Shield of California Full timeYour Role Reporting to the Senior Manager, Case Management - Behavioral Health, the Case Management – Clinician, Senior (Behavioral Health Care Manager) helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and program. The Case Management – Clinician, Senior will offer support...
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Case Management
3 weeks ago
Oakland, United States Blue Shield of California Full timeJob DescriptionYour RoleReporting to the Senior Manager, Case Management - Behavioral Health, the Case Management – Clinician, Senior (Behavioral Health Care Manager) helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and program. The Case Management – Clinician, Senior will...
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Licensed Clinician, Senior
3 weeks ago
Oakland, United States Blue Cross and Blue Shield Association Full timeYour Role The Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using Blue Shield of California (BSC) evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The Licensed Clinician,...
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2 days ago
Oakland, United States Blue Shield Of California Full timeJob DescriptionYour Role The Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using Blue Shield of California (BSC) evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The...
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1 month ago
Oakland, 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 Blue Shield of California (BSC) evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The Licensed Clinician,...
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Licensed Clinician, Senior
1 month ago
Oakland, United States Blue Shield Of California Full timeJob DescriptionYour RoleThe Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using Blue Shield of California (BSC) evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The...
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Licensed Clinician, Senior
2 weeks ago
Oakland, United States Blue Shield Of California Full timeJob Description Your Role The Behavioral Health Utilization Management team performs prospective, concurrent, retrospective utilization reviews and first level determination approvals for members using Blue Shield of California (BSC) evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The...
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Case Management
4 weeks ago
Oakland, CA, United States Blue Shield of California Full timeYour Role Reporting to the Senior Manager, Case Management - Behavioral Health, the Case Management – Clinician, Senior (Behavioral Health Care Manager) helps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and program. The Case Management – Clinician, Senior will offer support...
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Licensed Clinician, Senior
1 month ago
Oakland, 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 Blue Shield of California (BSC) evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The Licensed Clinician,...