Director, Behavioral Health Utilization Management

Your Role

Blue Shield of California is looking for a clinical leader to oversee the behavioral health utilization management for all product lines. Reporting to the Sr. Director, Behavioral Health Clinical Operations, the role of the Director, Behavioral Health Utilization Management is critical to the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives. This individual will play a key role as part of Utilization Management team in delivering and collaborating on all aspects of utilization management and care coordination for behavioral health membership for all lines of business. This leader will also provide direction and leadership in compliance to regulatory requirements and key operational metrics.

Your Knowledge and Experience

• Current CA RN License, LCSW, LMFT, LPCC, or PsyD by the Board of Behavioral Health Sciences.
• Requires a college degree or equivalent experience and minimum of 10 years prior relevant experience, including 6 years of management experience.
• Certified Case Manager (CCM) or is in process of completing certification when eligible based on CCM application requirements or National Certification in related field.
• Working knowledge of regulatory and accreditation standards preferred (URAC, NCQA, DMHC, CMS, DHCS)
• Knowledge of Coordination of Care, Medicare regulations, prior authorization, level of care and length of stay criteria sets desirable
• Requires broad management knowledge to lead project teams in one department/function or large centralized function.
• Master's Degree in a healthcare field preferred