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  • Licensed Clinician, Senior - Granite Bay - Blue Shield of California

    Blue Shield of California
    Blue Shield of California Granite Bay

    2 weeks ago

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    Description

    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 Licensed Clinician, Senior will report to the Manager, Behavioral Health Utilization Management. In this role you will be working with both the Utilization and Care Management teams, who provide utilization management, telephonic triage and care management assistance to members requesting access to Applied Behavioral Analysis (ABA) benefit.

    This role has a primary function of utilization management for our members seeking Behavioral Health Treatment (BHT).

    Your Work

    In this role, you will:

    • Perform prospective utilization reviews and first level determination for members using BSC evidenced based guidelines, policies and/or nationally recognized clinical criteria.
    • Review Functional Behavioral Assessments (FBA) and Board Certified Behavior Analyst (BCBA) Assessments submitted by providers for adherence to BACB

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Licensed clinician, senior