Manager, Program Management Clinical

Your Role

The Behavioral Health Utilization Management team performs prospective utilization review for our members and correctly applies the guidelines for nationally recognized levels of care. They collaborate directly with the Member, Member's Family, and Interdisciplinary Care Team to achieve consensus and promote positive Member health outcomes through the assessment, planning, implementation, and evaluation of the Member's Care Plan. The Promise Health Plan Manager, Program Management Clinical will report to the Senior Manager, Program Management Clinical. In this role you will be responsible for overseeing the day-to-day operations of the Blue Shield Promise Behavioral Health Treatment (BHT/ABA) team and execution of departmental goals and objectives. The goal of which is to promote the delivery of quality, cost-effective healthcare services based on medical necessity and contractual benefits across the continuum of care. 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 Knowledge and Experience

• Requires a master's degree in psychology or a related field
• Requires an active California Board Certified Behavior Analyst certification
• Requires at least 7 years of experience as a BCBA (Board Certified Behavior Analyst certification)
• Requires 3 years of management experience
• Understands basic management approaches such as work scheduling, prioritizing, coaching and process execution, work organization, risk management and delegation
• Has functional expertise within the area of responsibility (Outpatient Prior Authorization Medical Necessity Determinations) and ability to work in numerous applications, with a high level of technical skills
• Typically, requires advanced knowledge of job area (Applied Behavior Analysis) usually obtained through advanced education combined with experience
• Knowledge of Medi-Cal regulatory requirements, benefits and available resources is preferred