Description & Requirements Description Compensation:$26 - $32 Per Hour- Full time, based upon experiencePromotion opportunity to Program Supervisor (salaried) based upon experienceBenefits of Working at Intercare:Monthly Bonuses!Flexible work schedule with a focus on work/life balance; Manage your own scheduleMileage reimbursement, a company computer and cell phoneEducation tuition reimbursement program (Masters & BCBA)!Leadership training and CEUs - we will teach how to become a better leader!Medical, Dental, and Vision insuranceGenerous time off policy (vacation, sick time, and holidays)Company 401k PlanOutstanding mentorship and supportive environment for continual learningRequired Credentials/Experience:Completed Bachelor’s degree and either of the following:12 semester units of ABA course work with one (1) year experience implementing and/or designing ABA programmingTwo (2) years of experience designing or implementing ABA programsStrong ABA, Program Management,and clinical skillsExcellent written and spoken communication, time management skills, and interpersonal skillsAbility to give and receive constructive feedback with a team player attitudeBilingual skills valuedJob DescriptionIntercare Therapy provides evidence-based behavioral therapies that help children overcome challenges related to autism spectrum disorders. Our mission is to optimize the independence and quality of life of our clients and their families. We love what we do, and we are seeking Behavioral Program Managerswho share our passion for improving the lives of children and families affected by autism.A Behavioral Health or (ABA)Program Managerserves in the field as the onsite case supervisor and leader, mastering daily case management skills, including developing and overseeing clinical programs, supervising BIs and providing education and training for client caregivers. You must be willing to drive 30 to 60 miles a day, andable to supervise client sessions anytime between 8AM and 6PM on weekdays, and occasionally on weekends.We are proud to be the highest rated established ABA organization on Glassdoor! Check out our rankings and reviews on Glassdoor!Learn more about us on You Tube!This position may require the candidate be fully vaccinated for COVID-19 in accordance with all vaccination requirements set forth by Intercare funding sources and pursuant to any guidelines from the California Department of Health.Closing:If you have experience in any of the following fields, we encourage you to apply:Behavior Analyst, Autism, Social Learning, Social Skills, Developmental Condition, Psychology, Sociology, Social Services, Children, ABA, Applied behavior analysis, BCBAIntercare Therapy will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring (Ban the Box) Ordinance.Intercare Therapy supports a diverse workforce and is an Equal Opportunity Employer.

Your Role The Facility Compliance Review (FCR) team reviews post service prepayment facility claims for contract compliance, industry billing standards, medical necessity and hospital acquired conditions/never events . The Manager, Utilization Management Nurse Management will report to the Senior Manager, Facility Compliance Review . In this role you will be responsible for several direct reports, be a resource for problem solving issues, training and updating documentation as needed. You will work to enhance the department’s operations with efficiency and attention to detail/quality.Your Work In this role, you will: Establish operational objectives for department or functional area and participate with other managers to establish group objectivesBe responsible for team, department or functional area results in terms of planning, cost in collaboration with Sr ManagerDevelop and maintain FCR workflows, protocols, and policies to ensure efficient and effective care coordinationEnsure workflow procedures and guidelines are clearly documented and communicatedInterpret or initiate changes in guidelines/policies/proceduresMonitor and evaluate the performance of the FCR team and implement improvement strategies as neededKeeps team focused on specific and measurable performance goals and monitors performance against clear standards.Works collaboratively among business units to align and partner with others to achieve performance goals and/or outcomesProvide Ensure the delivery of high-quality, patient-centered care through the management of chronic disease, complex case management, and discharge planningOther duties as assigned by Sr ManagerYour Knowledge and Experience Requires a current CA RN LicenseBachelors of Science in Nursing or advanced degree preferred.Requires at least 7 years of prior relevant experience including 3 years of management experience gained as a team leader, supervisor, or project/program managerA minimum of 3+ year experience in inpatient or managed care environment preferredExcellent communication, interpersonal, and negotiation skillsHas functional expertise within the area of responsibility.Knowledge of NCQA requirements preferredAbility to analyze data and create reports to guide decision-making and process improvements

Role Overview Chili's Managers are wired for hospitality! We're in the people business. So, we know how to make someone feel special, and our most successful Managers are passionate about connecting with Team Members and Guests. Our win-together atmosphere rewards teamwork, and a willingness to go above and beyond is always recognized and celebrated.For decades, Chili's has been known for our culture of fun. Simply put - we take our jobs seriously but not ourselves. Our Managers are hungry for top business results but also know how to have fun along the way. From leading the team through a high-energy shift to exceeding Guest expectations on every occasion to ensuring we meet our financial responsibilities, Managers are the critical link to making it all happen. Responsibilities Ensure a great Guest experienceRole model and hold Team Members accountable to operational and quality standardsIdentify root cause of issues while being self-reflective and holding yourself accountable first, showing vulnerability and transparencyFoster open communication between Team Members and ManagementInfluence Team Member behaviors by championing change and restaurant initiativesLead with heart and mindDrive business results by utilizing Chili's systems to effectively control costsFollow operational systems, such as our Manager Timeline and performing quality Line ChecksHire, train, retain, and develop Team Members to take on larger rolesDrive Guest engagement within the four walls of the restaurant while developing relationships within the communityUnderstand and practice safe food handling proceduresCommunicate and embody Chili's culture and Cultural Beliefs: Every Guest Counts, Food Perfection, Be Accountable, Play Restaurant About Us Chili's was born in Dallas, Texas in 1975. Since then, we've boldly claimed our place in the casual dining industry as the place to go for Big Mouth burgers, house smoked ribs, full on fajitas, and hand shaken margaritas! With a legacy deeply rooted in service, hospitality, and giving back, we are committed to delivering the best experience to every Guest, every day. About You Dependable team playerPrefers to work in a fast-paced environmentGreat multitasking skills $65000 - $70000 yearly

Description & Requirements Description Compensation:$26 - $32 Per Hour- Full time, based upon experiencePromotion opportunity to Program Supervisor (salaried) based upon experienceBenefits of Working at Intercare:Monthly Bonuses!Flexible work schedule with a focus on work/life balance; Manage your own scheduleMileage reimbursement, a company computer and cell phoneEducation tuition reimbursement program (Masters & BCBA)!Leadership training and CEUs - we will teach how to become a better leader!Medical, Dental, and Vision insuranceGenerous time off policy (vacation, sick time, and holidays)Company 401k PlanOutstanding mentorship and supportive environment for continual learningRequired Credentials/Experience:Completed Bachelor’s degree and either of the following:12 semester units of ABA course work with one (1) year experience implementing and/or designing ABA programmingTwo (2) years of experience designing or implementing ABA programsStrong ABA, Program Management,and clinical skillsExcellent written and spoken communication, time management skills, and interpersonal skillsAbility to give and receive constructive feedback with a team player attitudeBilingual skills valuedJob DescriptionIntercare Therapy provides evidence-based behavioral therapies that help children overcome challenges related to autism spectrum disorders. Our mission is to optimize the independence and quality of life of our clients and their families. We love what we do, and we are seeking Behavioral Program Managerswho share our passion for improving the lives of children and families affected by autism.A Behavioral Health or (ABA)Program Managerserves in the field as the onsite case supervisor and leader, mastering daily case management skills, including developing and overseeing clinical programs, supervising BIs and providing education and training for client caregivers. You must be willing to drive 30 to 60 miles a day, andable to supervise client sessions anytime between 8AM and 6PM on weekdays, and occasionally on weekends.We are proud to be the highest rated established ABA organization on Glassdoor! Check out our rankings and reviews on Glassdoor!Learn more about us on You Tube!This position may require the candidate be fully vaccinated for COVID-19 in accordance with all vaccination requirements set forth by Intercare funding sources and pursuant to any guidelines from the California Department of Health.Closing:If you have experience in any of the following fields, we encourage you to apply:Behavior Analyst, Autism, Social Learning, Social Skills, Developmental Condition, Psychology, Sociology, Social Services, Children, ABA, Applied behavior analysis, BCBAIntercare Therapy will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring (Ban the Box) Ordinance.Intercare Therapy supports a diverse workforce and is an Equal Opportunity Employer.

Your Role The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinal criteria across multiple lines of business. The Behavioral Health Utilization Management Clinician, Senior, will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will conduct clinical review of mental health and substance use authorization requests at various levels of care for medical necessity, coding accuracy, medical policy compliance and contract compliance.Your Work In this role, you will: Perform prospective & concurrent utilization reviews and first level determination approvals for members admitted to facilities using BSC evidenced based guidelines, policies and nationally recognized clinal criteria across lines of business or for a specific line of business such as Medicare as neededGather clinical information and apply the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for medical director oversight and necessity determinationProvide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteriaWork with multidisciplinary teams to support members using an integrated team-based approach including Interdisciplinary Team Meetings and case consultations with Medical Director and/or Licensed ManagerRecognize the members right to self-determination as it relates to the ethical principle of autonomy, including the members/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsYour Knowledge and Experience Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) requiredAdvanced degree commensurate with field is preferredRequires at least five (5) years of prior experience in healthcare related fieldThree (3) years conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment requiredStrong understanding of Behavioral Health Utilization Management including ability to apply and interpret admission and continued stay criteria of multiple standardized clinical criteria sets including but not limited to MCG guidelines, nonprofit association guidelines, and various Medicare guidelinesFamiliarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab resultsProficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databasesExcellent analytical, communication skills, written skills, time management, and organizational skillsPossess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiativeAbility to identify problems and works towards problem resolution independently, seeking guidance as needed

Description & Requirements Description Compensation:$26 - $32 Per Hour- Full time, based upon experiencePromotion opportunity to Program Supervisor (salaried) based upon experienceBenefits of Working at Intercare:Monthly Bonuses!Flexible work schedule with a focus on work/life balance; Manage your own scheduleMileage reimbursement, a company computer and cell phoneEducation tuition reimbursement program (Masters & BCBA)!Leadership training and CEUs - we will teach how to become a better leader!Medical, Dental, and Vision insuranceGenerous time off policy (vacation, sick time, and holidays)Company 401k PlanOutstanding mentorship and supportive environment for continual learningRequired Credentials/Experience:Completed Bachelor’s degree and either of the following:12 semester units of ABA course work with one (1) year experience implementing and/or designing ABA programmingTwo (2) years of experience designing or implementing ABA programsStrong ABA, Program Management,and clinical skillsExcellent written and spoken communication, time management skills, and interpersonal skillsAbility to give and receive constructive feedback with a team player attitudeBilingual skills valuedJob DescriptionIntercare Therapy provides evidence-based behavioral therapies that help children overcome challenges related to autism spectrum disorders. Our mission is to optimize the independence and quality of life of our clients and their families. We love what we do, and we are seeking Behavioral Program Managerswho share our passion for improving the lives of children and families affected by autism.A Behavioral Health or (ABA)Program Managerserves in the field as the onsite case supervisor and leader, mastering daily case management skills, including developing and overseeing clinical programs, supervising BIs and providing education and training for client caregivers. You must be willing to drive 30 to 60 miles a day, andable to supervise client sessions anytime between 8AM and 6PM on weekdays, and occasionally on weekends.We are proud to be the highest rated established ABA organization on Glassdoor! Check out our rankings and reviews on Glassdoor!Learn more about us on You Tube!This position may require the candidate be fully vaccinated for COVID-19 in accordance with all vaccination requirements set forth by Intercare funding sources and pursuant to any guidelines from the California Department of Health.Closing:If you have experience in any of the following fields, we encourage you to apply:Behavior Analyst, Autism, Social Learning, Social Skills, Developmental Condition, Psychology, Sociology, Social Services, Children, ABA, Applied behavior analysis, BCBAIntercare Therapy will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the Los Angeles Fair Chance Initiative for Hiring (Ban the Box) Ordinance.Intercare Therapy supports a diverse workforce and is an Equal Opportunity Employer.

Your Role Work schedule is Mon-Fri 10am- 7pm The Federal Employee Program (FEP) team performs integrated case management (CM) and disease management (DM) activities demonstrating clinical judgment and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians. The Regional Registered Nurse Case Manager will report to the FEP Care Management Department Manager. In this role you will determine, develop, and implement a plan of care based on accurate and comprehensive assessment of the member’s needsYour WorkIn this role, you will:Coordinate care for lower level of care such Skilled Nursing Facility, Home Health, Home Infusion, Acute Rehab, Long-term Acute Care Hospital, Hospice, and other community program as appropriatePerform effective discharge planning and collaborate with member’s support system and health care professionals involved in the continuum of careProvides disease management education on core chronic conditions (Diabetes, Heart Failure, COPD, Asthma and Coronary Artery Disease). Outreach to members with HEDIS Care Gaps to assist with closureApply detailed knowledge of FEP PPO and Blue Shield of California's established medical/departmental policies, clinical practice guidelines, community resources, contracting and community care standards to each caseResearch and design treatment/care plans to promote quality of care, cost effective health care services based on medical necessity complying withcontract for each appropriate plan typeProvide Referrals to QualityManagement (QM), Disease Management (DM) and Appeals and Grievance department (AGD)Recognize the clients right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamDesign appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access and cost-effective outcomesInitiate and implement appropriate modifications in plan of care to adapt to changes occurring over time and through various settingsMust be able to sit for extended periods of time and read information on one computer screen and apply that information on a second computer screen to complete documentationYour Knowledge and ExperienceRequires a current CA RN License.Bachelor of Science in Nursing or advanced degree preferredCertified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirementsRequires at least 5 years of prior experience in nursing, healthcare or related field3+ years managed care experience preferred.Comprehensive knowledge of case management, discharge planning, utilization management, disease management and community resources preferredBehavioral health, oncology, or OB/NICU/pediatrics experience preferredStrong electronic clinical documentation skills, independent problem identification and resolution skillsKnowledge of coordination of care, prior authorization, level of care and length of stay criteria sets desirableCompetent understanding of NCQA and federal regulatory requirementsDemonstrate leadership, project management and program evaluation skills and ability to interact with all levels including senior management and influence decision-makingDemonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessity including intensity of service and severity of illness within contracted benefits and appropriate level of care

Your Role The Care Managementteam will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Case Management – Nurse, Senior will report to the Manager of Care Management. In this role you will play a pivotal role in assessing member needs, providing clinical education, as well as care coordinationwith providers, medical groups, and community resources. You will be responsible for managing and coordinating patient care, ensuring that our members receive the highest quality of care and services. Care Managers perform care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians.Your Work In this role, you will: Determine appropriateness of referral for CM services, mental health, and social servicesAssess members health behaviors, cultural influences and clients belief/value system. Evaluate all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriersResearch and design treatment/care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for each appropriate plan type. Adjust plans or create contingency plans as necessaryIdentify appropriate programs and services that align with member needs and preferencesInitiate timely Individualized Care Plans (ICP) based on Health Risk Assessment (HRA) completion, participation in and documentation of Interdisciplinary meetings (ICT), assisting in transitions of care across all agesProvide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD)Conduct member care review with medical groups or individual providers for continuity of care, out of area/out of network and investigational/experimental casesResearch opportunities for improvement in assessment methodology and actively promote continuous improvement. Anticipate potential barriers while establishing realistic goals to ensure success for the member, providers, and BSCDetermine realistic goals and objectives and provide appropriate alternatives. Actively soliciting client’s involvementRecognize need for contingency plans throughout the healthcare processProvide education and support to members and their families regarding health conditions, treatment options, and community resourcesFollow up with members as appropriate to ensure they have successfully connected with recommended programs and servicesYour Knowledge and Experience Requires a current and valid CA RN License or valid RN license(s) from other state(s). Preferred licensure from a compact state. If assigned to another state, must maintain an active, unrestricted RN license in assigned state(s) or the ability to obtain required RN license (in addition to primary state license) within 90 days of hireBachelor of Science in Nursing or advanced degree preferredCertified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirementsRequires 5 years experience in nursing, healthcare, or related field A minimum of 3 years managed care experience in inpatient, outpatient, or managed care environment preferredHealth insurance/managed care experience preferredTransitions of care experience preferredStrong knowledge of healthcare delivery systems, managed care principles, and care coordinationExcellent communication skills

Your Role Reporting to the Sr. Director, Utilization Management, the role of the Director, Medicare & Medi-Cal Utilization Management is critical to the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives.This individual will play a key role as part of the Utilization Management team in delivering and collaborating on all aspects of utilization management and care coordination for our Medicare and Medi-Cal membership. The Director, Medicare & Medi-Cal Utilization Management role will also provide direction and leadership in compliance to regulatory requirements and key operational metrics.Your Work In this role, you will: Manages and monitors prior authorization and concurrent review to ensure that the patient is getting the right care in a timely and cost-effective way.Leading development of UM strategy by leveraging the use of data/analytics to inform and technology solutions to streamline operational efficiencies while also building a cost-benefit methodology to rationalize decisions on UM reviews to be performed based upon staffing costs, productivity, and projected medical cost savings.Provides analysis and reports of significant utilization trends, patterns, and resource allocation.Partners with physicians and others to develop improved utilization of effective and appropriate services.Establishing and measuring productivity metrics to support workforce planning methodology and rationalization of services required to perform UM reviews.Reviewing and reporting out on Utilization Review (UR) trending for Medicare and Medi-Cal membership.Ensuring alignment of the authorization strategy with clinical policy, payment integrity, and network development strategies to optimize quality and cost of care.Responsible for managing strategic projects and supporting operations initiatives.Leading operational implementation of transformation changes (organizational management, process implementation, technology adoption).Responsible for operational teams' performance, resource management, continuous improvement, and training.Responsible for operational audit readiness, ensuring adequate processes and internal audit measures in place and maintained quarterly.Ensuring all operational processes are meeting regulatory and accreditation requirements.Fosters a culture of process excellence, BSC leadership principles, and a great place to work environment.Occasional business travel required.Your Knowledge and Experience Requires current CA RN LicenseBachelor’s of Science in Nursing or advanced degree preferredMaster’s degree or equivalent experience preferredMinimum of 10 years of Utilization Management or relevant experience, including 6 years of management experienceMinimum of 5 years of progressive leadership in Utilization Management operationsHealth plan or similar health care organization structure experience requiredSuccessful track record in driving organizational change managementExcellent relationship and consensus-building skills required

Your Role The Care management team is looking for a leader with Medi-Cal experience who can help design and lead our Medi-Cal line of business. The Senior Manager of Care Management, Medi-Cal will report to the Director of Care Management in the Population Health Department.. In this role you will be will serve as the professional leader of registered nurses within Blue Shield care management who is a good collaborator, experienced in people leadership, and will serve as a mentor and advisor to senior leadership. The selected candidate will also function as the subject matter expert on professional nursing/ care management for Medi-Cal regulations- who will represent care management in initiatives, client presentations, act as a liaison between other business units within Blue Shield to bolster care management knowledge on community resources, best practices, and promote holistic and integrated approach to medical care management..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,buildingand sustaining high-performing teams, getting results the right way, and fostering continuous learning.Your WorkYour WorkIn this role, you will:Establish operational objectives for department or functional area andparticipatesand leads other managers to establish group objectivesBe responsible for team, department or functional area results in terms of planning, cost and methods in collaboration with DirectorParticipate in the development and implementation of the annual budget under the direction of DirectorEnsure workflow procedures and guidelines are clearly documented and communicatedInterpret or initiate changes in guidelines/policies/proceduresProvides leadership to ensure best utilization of resources in obtaining organizational goals, regulatory compliance, adhering to corporate policies through oversight of daily operations, assessment of adequacy of staffing, and adherence to standard of social workersEnhancement or creation of care management processes in compliance with regulatory requirementsMaintenance and operationalizing of the Model of Care (MOC) for Medi-Cal SPD members, Cal-AIM, and other contracts with DHCS and CMS in close collaboration with and guidance from Director of Care ManagementResponsible for ensuring that the care management department readiness for internal and external regulatory and accreditation auditsPrimary involvement with committees, projects, initiatives, professional associations, and other service providers to promote appropriate and cost-effective care delivery for the populationFocused on services and programs to increase quality of life and health of all membersMacro level collaboration and involvement with committees, projects, initiatives, community leaders, county social service personnel, professional associations, and other service providers to promote appropriate and cost-effective care delivery for the populationDemonstrates a passion for leading positive change by enhancement and sustainment of an innovative care management program that advocates for patient safety by keeping informed of mandates, regulations, and best practice innovationsEnhancement and development of client health education, Advance Healthcare Planning and End of Life counseling and support and promotes participation in staff, patient, and community educationPromotion of best practice in impacting social determinants of health and homelessnessRepresent Blue Shield care management in Blue Shield sponsored community events and fairsRegular collaboration with other Blue Shield managers in care management and other business unitsMaintain daily measurement standards and outcomes for staffAn active participant in practice transformationYour Knowledge and ExperienceRequires a bachelor's degree or equivalent experienceRequires a current CA RN LicenseCertified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirementsRequires at least 10 years of prior relevant experience including 4 years of management experience gained as a team leader, supervisor, or project/program managerRequires health insurance/managed care experience (Commercial, Medicare, and Medi-Cal).Requires excellent communication, presentation, and procedure-writing skillsLean methodology desiredAdvanced degree preferred

Your Role The Behavioral Health (BH) Utilization Management (UM) team performs prospective, concurrent, retrospective utilization reviews and first level determinations for members using BSC evidenced based guidelines, policies, and nationally recognized clinical criteria across multiple lines of business. The Behavioral Health Utilization Management, Consultant (Lead), will report to the Manager of Behavioral Health Utilization Management (BH UM). In this role you will support the clinicians with daily operations, provide coaching, and serve as the subject matter expert for the BH UM team as they conduct clinical reviews of mental health and substance use authorization requests at various levels of care for medical necessity.Your WorkIn this role, you will:Facilitate communication between leadership, Medical Directors, and non-clinical leads to address line staff questions and issues; escalate matters to management with recommendations or consultation as neededLead onboarding/training of incoming staff, provide proactive and guided support through the onboarding processMaintain and gain knowledge of behavioral health utilization management through team and departmental expansion as neededAct as subject matter expert to review and evaluate the effectiveness of operational workflows to identify problems and develop improvements, modifications, and enhancementsDevelop and evaluate tools and materials that enhance operating efficiency, accuracy, and technical skill levels of unit staffAssist with audit readiness in collaboration with internal BSC partnersPerform advanced or complicated prior authorization and concurrent utilization reviews and first level determinations for members using non-profit association guidelines ensure discharge (DC) planning at levels of care appropriate for the members needs and acuity; prepare and present cases to Medical Director (MD) for oversight and necessity determinationIdentify process and control improvement opportunities and provide recommendations that help improve the effectiveness, efficiency and/or economic value of a control or processProvide guidance, coaching and training on internal behavioral health utilization management processes to other employees across the company as appropriateLead, manage, and execute other special projects and team initiatives as assignedLead team huddles/meetings to support processes and collaboration of team membersSupport team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standardsYour Knowledge and ExperienceCurrent unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) requiredAdvanced degree commensurate with field is preferredRequires at least seven (7) years of prior experience in healthcare related fieldExperience operating in a lead role or equivalent leadership training is preferredFive (5) years conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment preferredDeep knowledge of Behavioral Health Utilization Management including ability to apply and interpret admission and continued stay clinical against nonprofit association guidelinesFamiliarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab resultsProficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databasesExcellent analytical, communication skills, written skills, time management, and organizational skillsPossess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiativeAbility to identify problems and works towards problem resolution independently, seeking guidance as needed

Your Role Reporting to the Manager, Care Management- Behavioral Health, the Behavioral Health Care Management Clinician, Seniorhelps members with behavioral health needs navigate the health care system for linkages to behavioral health providers, treatment, and programs. The Behavioral Health Care Manager will offer support in assessing members’ emotional and psychological well-being and providing resource coordination, crisis intervention, substance abuse, and with any behavioral or mental health referrals. The Behavioral Health Care Management Clinician, Senior will be available to physicians and nurse care managers as a consultant for patients with complex psychosocial needs. The position requires an intensive focus on crisis intervention and counseling, problem-solving and conflict resolution, patient and family management, interdisciplinary collaboration, psychosocial assessments, education, advocacy, and community resource linkages.Your Work In this role, you will: Collaborate with case managers and other team members tocomplete member assessments related to social and resource needs tosupportmemberaccess to servicesCollaborate with service coordination staff and act as liaison to ensure a timely and accurate response to member needsCollaborate with providers to support members’ treatment plan and care needsRecognize the client’s right to self-determination as it relates to the ethical principle of autonomy, including the client/family's right to make informed choices that may not promote the best outcomes, as determined by the healthcare teamAssessmembers health behaviors, cultural influences and clients belief/value systemand evaluates all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriersEfficiently manages and maintains a caseload of members for behavioral health care coordination and or BH case management for persons experiencing severe and persistent mental illness.Maintains an active workload in accordance with National Care Manager performance standards.Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.Interacts with Utilization department and Physician Advisors to discuss clinical questions and concerns regarding specific cases.Coordinates services with state and community programs on behalf of the member, particularly when the member is unable to effectively do so independentlyAs a mandated reporter, files and follows-up on reports made to the appropriate government agency (e.g., Adult Protective Services, Child Protective Services, etc.)Actively participates in Interdisciplinary Team Meetings and case consultations with Licensed Manager.)Your Knowledge and Experience Current unrestricted CA License (LCSW, LMFT, LPCC, Registered Nurse (RN), or PsyD by the Board of Behavioral Health Sciences requiredAdvanced degree commensurate with field is preferredRequires at least five (5) years of prior relevant experience, including three (3) years of experience in behavioral health.Certified Case Manager preferredExperience conducting thorough psychosocial assessments, developing care plans and providing necessary interventions identified during assessment with complex client populations that may have, among other things, inadequate coping skills, severe emotional disorders, developmental disabilities, mental illnesses, and/or unstable housingConsiderable knowledge of a wide range of psychosocial challenges and familiarity with behavioral health diagnoses and treatmentProficient with computer programs such as Microsoft Excel, Outlook, Word, and PowerPoint