Behavioral Health Utilization Mgmt

JOB REQUIREMENTS: Your Role The Behavioral Health Utilization Managementteam performs prospective & concurrent utilization reviews and firstlevel determinations for members using BSC evidenced based guidelines,policies, and nationally recognized clinal criteria across multiplelines of business. The Behavioral Health Utilization ManagementClinician, Senior, will report to the Manager of Behavioral HealthUtilization Management (BH UM). In this role you will conduct clinicalreview of mental health and substance use authorization requests atvarious levels of care for medical necessity, coding accuracy, medicalpolicy compliance and contract compliance. Your Knowledge and ExperienceCurrent unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN withBehavioral Health experience) required Advanced degree commensurate withfield is preferred Requires at least five (5) years of prior experiencein healthcare related field Three (3) years conducting Behavioral HealthUtilization Management for a health insurance plan or managed careenvironment required Strong understanding of Behavioral HealthUtilization Management including ability to apply and interpretadmission and continued stay criteria of multiple standardized clinicalcriteria sets including but not limited to MCG guidelines, nonprofitassociation guidelines, and various Medicare guidelines Familiarity withmedical terminology, diagnostic terms, and treatment modalitiesincluding ability to comprehend psychiatric evaluations, clinical notes,and lab results Proficient with Microsoft Excel, Outlook, Word, PowerPoint, and the ability to learn and utilize multiple systems/databasesExcellent analytical, communication skills, written skills, timemanagement, and organizational skills Possess outstanding interpersonal,organizational, and communication skills, positive attitude, and highlevel of initiative Ability to identify problems and works towardsproblem resolution independently, seeking guidance as needed Externalhires must pass a background check/drug screen. Qualified applicantswith arrest records and/or conviction records will be considered foremployment in a manner consistent with Federal, State and local laws,including but not limited to the San Francisco Fair Chance Ordinance.All qualified applicants will receive consideration for employmentwithout regards to race, color, religion, sex, national origin, sexualorientation, gender identity, protected veteran status or disabilitystatus and any other classification protected by Federal, State andlocal laws. APPLICATION INSTRUCTIONS: Apply Online:ipc.us/t/D0689B1040F14720

Created: 2025-12-25