Your Role

The Utilization Management team processes Medical and Behavioral Health prior authorization and concurrent review requests for BSC membership. The Program Manager, Consultant will report to the Sr. Manager Behavioral Health Utilization Management. In this role you will oversee and ensure Utilization Management compliance with federal and California State mental health parity requirements.

Your Knowledge and Experience

• Requires a bachelor's degree or equivalent experience
• Requires at least 7 years of prior relevant experience
• Requires prior relevant experience in a managed care setting with knowledge of compliance and regulatory affairs
• In-depth knowledge of federal (CAA 203) and California state (SB855) Mental Health Parity laws
• Strong understanding of Behavioral Health Utilization Management
• Strong analytical skills, including the ability to interpret and determine the impact of complex laws, regulations and other documents
• The ability to independently achieve objectives and resolve issues under ambiguous circumstances
• Strong decision-making, organizational, planning, and problem-solving skills, and communication skills are needed to effectively interact with staff, team members and others in a professional and tactful manner.
• Strong presentation skills with the ability to tailor presentations to a specific audience, and address and interact with large groups preferred

Pay Range:

The pay range for this role is: $ 109120.00 to $ 163680.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

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