Your Role

The Behavioral Health Clinical team processes all prior authorization and concurrent review requests for the BSC membership . The Behavioral Health Clinical manager will report to the Sr Manager of Behavioral Health Utilization Management . In this role you will be responsible for overseeing the day-to-day operations of the business unit 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 Work

In this role, you will:

• Establish operational objectives for department or functional area and participate with other managers to establish group objectives
• Be responsible for team, department or functional area results in terms of planning, cost in collaboration with Sr Manager
• Participate in the development and implementation of the annual budget under the direction of Sr Manager / Director
• Ensure workflow procedures and guidelines are clearly documented and communicated
• Interpret or initiate changes in guidelines/policies/procedures
• May lead special projects/committees/task forces which require Collaboration with internal business partners relating to Utilization Management, Delegation Oversight, Claims and Customer Service
• Develop and implement recommendations for improvement of quality and can interpret statistics and plan for actions taken to improve prior auth and concurrent review processes
• Ability to stay current on regulatory changes and industry requirements and to design and implement tools and materials that are compliant with contractual, regulatory, legislative and Blue Shield mandated requirements
• Ability to design work plans and workflows to facilitate audit and quality initiatives and be able to report and analyze oversight metrics and make process recommendations where appropriate
• Communicates with parties within and outside of the operational team, which may include external customers or vendors