Senior Licensed Clinician

3 weeks ago

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

We are seeking a highly skilled Senior Licensed Clinician to join our Behavioral Health Utilization Management team at Blue Shield of California. In this role, you will play a critical part in ensuring that our members receive the necessary care and support to achieve optimal health outcomes.

Key Responsibilities
  • Conduct thorough clinical reviews of mental health and substance use authorization requests to determine medical necessity, coding accuracy, and compliance with medical policy and contract requirements.
  • Collaborate 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.
  • 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, and medical necessity criteria.
  • Support the team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standards.
Requirements
  • Current and unrestricted CA RN, MFT, LCSW, BCBA, LPCC, or psychologist license.
  • Minimum of 5 years of prior relevant experience.
  • Bachelor of Science or advanced degree is preferred.
  • Three (3) years conducting Utilization Management for a health insurance plan or managed care environment is preferred.
  • Strong understanding of behavioral health utilization management, including application of multiple standardized clinical criteria sets.
  • Proficiency with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databases.
What We Offer

We offer a competitive salary range of $87,230.00 to $130,900.00 for California, as well as a comprehensive benefits package and opportunities for professional growth and development.

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