Sr. Manager, Behavioral Health Utilization Management
Company: Blue Shield of California
Location: El Dorado Hills
Posted on: July 20, 2025
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Job Description:
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
Keywords: Blue Shield of California, Alameda , Sr. Manager, Behavioral Health Utilization Management, Healthcare , El Dorado Hills, California
