Sr. Manager, Behavioral Health Utilization Management

Your Role

The Behavioral Health Utilization Management (UM) team performs prior authorization and concurrent reviews by apply evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The Sr. Manager, Program Management Clinical will report to the Director, Behavioral Health Utilization Management. In this role you will be responsible for managing all aspects of day-to-day operations of the Behavioral Health UM program, including adherence to regulatory compliance and direct oversight of performance quality. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Your Work

In this role, you will:

• Ensure effective caseload management to achieve regulatory timelines, accreditation standards and contract requirements
• Be responsible for Behavioral Health Program oversight, including staffing forecasts
• Represent BH Utilization Management as the Subject Matter Expert during in internal and external audit preparation and presentation
• Be responsible for team, department or functional area results in terms of planning, cost and methods in collaboration with Director
• Participate in the development and implementation of the annual budget under the direction of Director

Your Knowledge and Experience

• Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) required; requires a bachelor's degree
• Requires at least (ten) 10 years of prior relevant experience
• Requires (four) 4 years of management experience which includes the supervision of clinical staff
• Three (3) years conducting Utilization Management for a health plan
• Strong understanding of behavioral health utilization management including application of multiple standardized clinical criteria sets including but not limited to MCG guidelines, nonprofit association guidelines, and various Medicare guidelines