Sr. Manager, Behavioral Health Utilization Management

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.

Responsibilities

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

Qualifications

Your Knowledge and Experience

About the Team

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!

Our Values :

Our Workplace Model :

At Blue Shield of California and the Ascendiun Family of Companies, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose - whether working in the office or through a hybrid approach - by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working :

o Member-facing and approved out-of-state roles remain remote.

o Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.

o For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

Physical Requirements :

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office / deskwork - Activity level : Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity :

External hires must pass a background check / drug screen. Qualified applicants with arrest records and / or conviction records will be considered for employment 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 employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.