145 Healthcare jobs in Vacaville

Mental Health Therapist

97112 Dixon, California SonderMind Careers

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Job Description

SonderMind is a leading mental health care platform revolutionizing therapy services. We are seeking compassionate and highly skilled licensed mental health therapists to join our expanding network.

As a SonderMind therapist, you will have the opportunity to meaningfully impact the lives of individuals seeking therapy while enjoying the flexibility and support of our innovative platform.

Our therapists are committed to delivering best-in-class care to all individuals by focusing on high-quality clinical outcomes – and finding new ways to use data to help people get better.

At SonderMind, we enable clinicians to thrive.

Benefits of Joining SonderMind:

  • Flexibility: Enjoy the freedom to set your own working hours and maintain a healthy work-life balance. Sessions can be conducted via telehealth or in-person.
  • Free and stress-free credentialing with major insurers: We have streamlined the credentialing process and handle all the hard stuff for you so that you can expand your practice by accepting insurance from major payors in your state in weeks, not months.
  • Exclusive Insurance Payor Access: Only SonderMind provides complimentary credentialing for both traditional Medicare and Medicare Advantage plans, including Humana and United Healthcare.
  • Clinical Autonomy : SonderMind values your clinical expertise and empowers you to make informed decisions about treatment approaches
  • Supportive Community: Access a network of like-minded therapists, dedicated support from our platform, and ongoing opportunities for collaboration and growth
  • Guaranteed Pay: We handle all the billing for you and guarantee pay bi-weekly for completed sessions-including no-shows
  • Thoughtful client matching and dedicated coaches to grow your practice: We help you get paired with individuals who are ideal clinical matches so that you can control and personalize your caseload, and a dedicated coach to help you help your clients, no matter what your specialty, from pediatric to geriatric mental health, trauma, anxiety or addiction, we help you help others
  • Professional Development: SonderMind is committed to helping therapists grow professionally, offering ongoing training and resources to enhance skills
  • Absolutely no fees or membership charges : We don’t charge you to deliver care, and all of the features, access, tools, and resources you get come free of charge

Requirements:

  • Master's degree or higher in counseling, psychology, social work, or a related field.
  • Must be fully licensed by the State Board to provide therapy independently and without supervision (e.g., LPC, LCSW, LMFT, LMHC, LCPC, LCSW-C, LISW, or LP).

Pay: $80-$110 per hour. Pay rates are based on the provider license type, session location, and session types.

*Please note that SonderMind does not provide office space; therapists are responsible for securing their own location for in-person sessions, but we can help connect you with Sondermind therapists looking to share space.

View Now

Mental Health Therapist

97112 Dixon, California SonderMind Careers

Posted today

Job Viewed

Tap Again To Close

Job Description

SonderMind is a leading mental health care platform revolutionizing therapy services. We are seeking compassionate and highly skilled licensed mental health therapists to join our expanding network.

As a SonderMind therapist, you will have the opportunity to meaningfully impact the lives of individuals seeking therapy while enjoying the flexibility and support of our innovative platform.

Our therapists are committed to delivering best-in-class care to all individuals by focusing on high-quality clinical outcomes – and finding new ways to use data to help people get better.

At SonderMind, we enable clinicians to thrive.

Benefits of Joining SonderMind:

  • Flexibility: Enjoy the freedom to set your own working hours and maintain a healthy work-life balance. Sessions can be conducted via telehealth or in-person.
  • Free and stress-free credentialing with major insurers: We have streamlined the credentialing process and handle all the hard stuff for you so that you can expand your practice by accepting insurance from major payors in your state in weeks, not months.
  • Exclusive Insurance Payor Access: Only SonderMind provides complimentary credentialing for both traditional Medicare and Medicare Advantage plans, including Humana and United Healthcare.
  • Clinical Autonomy : SonderMind values your clinical expertise and empowers you to make informed decisions about treatment approaches
  • Supportive Community: Access a network of like-minded therapists, dedicated support from our platform, and ongoing opportunities for collaboration and growth
  • Guaranteed Pay: We handle all the billing for you and guarantee pay bi-weekly for completed sessions-including no-shows
  • Thoughtful client matching and dedicated coaches to grow your practice: We help you get paired with individuals who are ideal clinical matches so that you can control and personalize your caseload, and a dedicated coach to help you help your clients, no matter what your specialty, from pediatric to geriatric mental health, trauma, anxiety or addiction, we help you help others
  • Professional Development: SonderMind is committed to helping therapists grow professionally, offering ongoing training and resources to enhance skills
  • Absolutely no fees or membership charges : We don’t charge you to deliver care, and all of the features, access, tools, and resources you get come free of charge

Requirements:

  • Master's degree or higher in counseling, psychology, social work, or a related field.
  • Must be fully licensed by the State Board to provide therapy independently and without supervision (e.g., LPC, LCSW, LMFT, LMHC, LCPC, LCSW-C, LISW, or LP).

Pay: $80-$110 per hour. Pay rates are based on the provider license type, session location, and session types.

*Please note that SonderMind does not provide office space; therapists are responsible for securing their own location for in-person sessions, but we can help connect you with Sondermind therapists looking to share space.

View Now

Clinical Psychologist (PsyD, PhD) - Vallejo, CA

94591 Vallejo, California LifeStance Health

Posted today

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Job Description

At LifeStance Health, we believe in a truly healthy society where mental and physical healthcare are unified to make lives better. Our mission is to help people lead healthier, more fulfilling lives by improving access to trusted, affordable, and personalized mental healthcare. Everywhere. Every day. It’s a lofty goal; we know. But we make it happen with the best team in behavioral health. 


Thank you for taking the time to explore a career with us. As the fastest growing behavioral health practice group in the country, now is the perfect time to join our clinical team!



We are actively looking to hire talented Psychologists in the area, who are passionate about patient care and committed to clinical excellence.

We offer Psychologists:
  • Compensation range of $136K to $182K based on production.
  • Flexible work schedules.
  • Telemedicine and in-person flexibility.
  • Full benefits package: health, dental, vision, life, 401k (with match), paid parental leave, EAP and more.
  • Collegial work environment.
  • Full administrative support.
  • Latest in digital technology.
  • Strong work/life balance.
Psychologists are a critical part of our clinical team. We’re seeking Psychologists that are:
  • Fully licensed and credentialed in California, including a Ph.D. or Psy.D.
  • Experienced with caring for adult and/or child and adolescent populations.


To learn more about this position contact Jackie at jackie.Kalpin @lifestance.com


About LifeStance Health 

LifeStance is a national provider of mental healthcare services focused on evidenced-based, medically driven treatment services for children, adolescents and adults suffering from a variety of mental health issues in an outpatient care setting, both in-person at its clinics nationwide and through its digital health telemedicine offering. The company employs psychiatrists, psychologists, psychiatric nurse practitioners, and licensed therapists throughout the US.


LifeStance Health is an equal opportunity employer. We celebrate diversity and are fully committed to creating an inclusive work environment for all our employees.


Our values:

Belonging: We cultivate a space where everyone can show up as their authentic self.

Empathy: We seek out diverse perspectives and listen to learn without judgment.

Courage: We are all accountable for doing the right thing - even when it's hard - because we know it's worth it.

One Team: We realize our full potential when we work together towards our shared purpose.


If you elect to interact with us via our website, please only use   or  .  Additionally, our recruiters utilize email addresses with the  @lifestance.com  domain. Other websites and domains are not affiliated with LifeStance Health and may represent threats to your data security.


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Behavioral Health Utilization Management Clinician, Experienced

94590 Vallejo, California Blue Shield of California

Posted today

Job Viewed

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Job Description

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, Experienced, 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 needed
  • Gather 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 determination
  • Provide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteria
  • Work 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 Manager
  • Recognize 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 team 
  • Support team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standards

Your Knowledge and Experience

  • Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) required
  • Advanced degree commensurate with field is preferred
  • Requires at least three (3) years of prior experience in healthcare related field
  • One (1) year conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment preferred
  • Strong 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 guidelines
  • Familiarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab results
  • Proficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databases 
  • Excellent analytical, communication skills, written skills, time management, and organizational skills 
  • Possess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiative
  • Ability to identify problems and works towards problem resolution independently, seeking guidance as needed
View Now

Medical Director, Behavioral Health

94591 Vallejo, California Blue Shield of California

Posted today

Job Viewed

Tap Again To Close

Job Description

Your Role

The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Medical Director, Behavioral Health will report to the Senior Medical Director, Behavioral Health. In this role you will have core responsibilities in the areas of behavioral health concurrent review, pre- and post-service utilization review, and collaboration with Clinical Care Managers. 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:

  • Review concurrent, pre- and post-service behavioral health service requests and render decisions based on the member's benefits, medical necessity, Blue Shield of California medical policy, FEP (Federal Employee Program) medical policy, as well as legal and regulatory requirements
  • Medical decision and support for the behavioral health review for all services currently requiring authorization or review, facilitating appropriate use of all resources, including safe and timely discharges
  • Engage in telephonic peer-to-peer discussions regarding current members in various levels of care or who may be receiving other specialized services. Therefore, the Medical Director must feel comfortable in clinical conversations with Blue Shield providers
  • Train BSC utilization and care management staff which may include physicians, psychologists, nurses, social workers, and others as needed
  • Perform clinical reviews to support utilization management and fraud waste and abuse case evaluations
  • Participate with the quality management function in the identification and analysis of medical information to develop interventions to improve quality of care and outcomes for our members
  • Participate on projects and committees, as necessary

     

Your Knowledge and Experience

  • Minimum 5 years direct patient behavioral health clinical care experience post residency required
  • Medical degree (M.D./D.O.)
  • Completed residency in Psychiatry
  • Maintain active, unrestricted California Medical License required; Maintain active, unrestricted Medical License in all additional assigned states required
  • Maintain Board Certification in Psychiatry through American Board of Psychology and Neurology (ABPN) or the American Osteopathic Board of Neurology and Psychiatry (AOBNP) required

Preferred Qualifications:

  • Recent inpatient psychiatric hospital experience (within the past five years)
  • Recent substance use disorders treatment experience (within the past five years)
  • Well-versed with most areas of behavioral health services and conditions
  • Show ability for rapid, accurate decision-making, and enjoy care review, as well as the investigation and resolution of complex issues
  • Experience with CPT coding, medical claims review, hospital billing, and reimbursement
  • Deep knowledge of MHPAEA (Mental Health Parity and Addiction Equity Act), SB855 and all regulatory and compliance requirements
  • Managed care experience supporting utilization management, case review, and/or quality improvement activities in behavioral health
  • Experience with ASAM, LOCUS, CALOCUS, and WPATH

View Now

Medical Director, Behavioral Health

94590 Vallejo, California Blue Shield of California

Posted today

Job Viewed

Tap Again To Close

Job Description

Your Role

The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Medical Director, Behavioral Health will report to the Senior Medical Director, Behavioral Health. In this role you will have core responsibilities in the areas of behavioral health concurrent review, pre- and post-service utilization review, and collaboration with Clinical Care Managers. 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:

  • Review concurrent, pre- and post-service behavioral health service requests and render decisions based on the member's benefits, medical necessity, Blue Shield of California medical policy, FEP (Federal Employee Program) medical policy, as well as legal and regulatory requirements
  • Medical decision and support for the behavioral health review for all services currently requiring authorization or review, facilitating appropriate use of all resources, including safe and timely discharges
  • Engage in telephonic peer-to-peer discussions regarding current members in various levels of care or who may be receiving other specialized services. Therefore, the Medical Director must feel comfortable in clinical conversations with Blue Shield providers
  • Train BSC utilization and care management staff which may include physicians, psychologists, nurses, social workers, and others as needed
  • Perform clinical reviews to support utilization management and fraud waste and abuse case evaluations
  • Participate with the quality management function in the identification and analysis of medical information to develop interventions to improve quality of care and outcomes for our members
  • Participate on projects and committees, as necessary

     

Your Knowledge and Experience

  • Minimum 5 years direct patient behavioral health clinical care experience post residency required
  • Medical degree (M.D./D.O.)
  • Completed residency in Psychiatry
  • Maintain active, unrestricted California Medical License required; Maintain active, unrestricted Medical License in all additional assigned states required
  • Maintain Board Certification in Psychiatry through American Board of Psychology and Neurology (ABPN) or the American Osteopathic Board of Neurology and Psychiatry (AOBNP) required

Preferred Qualifications:

  • Recent inpatient psychiatric hospital experience (within the past five years)
  • Recent substance use disorders treatment experience (within the past five years)
  • Well-versed with most areas of behavioral health services and conditions
  • Show ability for rapid, accurate decision-making, and enjoy care review, as well as the investigation and resolution of complex issues
  • Experience with CPT coding, medical claims review, hospital billing, and reimbursement
  • Deep knowledge of MHPAEA (Mental Health Parity and Addiction Equity Act), SB855 and all regulatory and compliance requirements
  • Managed care experience supporting utilization management, case review, and/or quality improvement activities in behavioral health
  • Experience with ASAM, LOCUS, CALOCUS, and WPATH

View Now

Behavioral Health Utilization Management Clinician, Experienced

94591 Vallejo, California Blue Shield of California

Posted today

Job Viewed

Tap Again To Close

Job Description

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, Experienced, 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 needed
  • Gather 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 determination
  • Provide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteria
  • Work 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 Manager
  • Recognize 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 team 
  • Support team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standards

Your Knowledge and Experience

  • Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) required
  • Advanced degree commensurate with field is preferred
  • Requires at least three (3) years of prior experience in healthcare related field
  • One (1) year conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment preferred
  • Strong 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 guidelines
  • Familiarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab results
  • Proficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databases 
  • Excellent analytical, communication skills, written skills, time management, and organizational skills 
  • Possess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiative
  • Ability to identify problems and works towards problem resolution independently, seeking guidance as needed
View Now
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Medical Director, Behavioral Health

94525 Crockett, California Blue Shield of California

Posted today

Job Viewed

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Job Description

Your Role

The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Medical Director, Behavioral Health will report to the Senior Medical Director, Behavioral Health. In this role you will have core responsibilities in the areas of behavioral health concurrent review, pre- and post-service utilization review, and collaboration with Clinical Care Managers. 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:

  • Review concurrent, pre- and post-service behavioral health service requests and render decisions based on the member's benefits, medical necessity, Blue Shield of California medical policy, FEP (Federal Employee Program) medical policy, as well as legal and regulatory requirements
  • Medical decision and support for the behavioral health review for all services currently requiring authorization or review, facilitating appropriate use of all resources, including safe and timely discharges
  • Engage in telephonic peer-to-peer discussions regarding current members in various levels of care or who may be receiving other specialized services. Therefore, the Medical Director must feel comfortable in clinical conversations with Blue Shield providers
  • Train BSC utilization and care management staff which may include physicians, psychologists, nurses, social workers, and others as needed
  • Perform clinical reviews to support utilization management and fraud waste and abuse case evaluations
  • Participate with the quality management function in the identification and analysis of medical information to develop interventions to improve quality of care and outcomes for our members
  • Participate on projects and committees, as necessary

     

Your Knowledge and Experience

  • Minimum 5 years direct patient behavioral health clinical care experience post residency required
  • Medical degree (M.D./D.O.)
  • Completed residency in Psychiatry
  • Maintain active, unrestricted California Medical License required; Maintain active, unrestricted Medical License in all additional assigned states required
  • Maintain Board Certification in Psychiatry through American Board of Psychology and Neurology (ABPN) or the American Osteopathic Board of Neurology and Psychiatry (AOBNP) required

Preferred Qualifications:

  • Recent inpatient psychiatric hospital experience (within the past five years)
  • Recent substance use disorders treatment experience (within the past five years)
  • Well-versed with most areas of behavioral health services and conditions
  • Show ability for rapid, accurate decision-making, and enjoy care review, as well as the investigation and resolution of complex issues
  • Experience with CPT coding, medical claims review, hospital billing, and reimbursement
  • Deep knowledge of MHPAEA (Mental Health Parity and Addiction Equity Act), SB855 and all regulatory and compliance requirements
  • Managed care experience supporting utilization management, case review, and/or quality improvement activities in behavioral health
  • Experience with ASAM, LOCUS, CALOCUS, and WPATH

View Now

Behavioral Health Utilization Management Clinician, Experienced

94525 Crockett, California Blue Shield of California

Posted today

Job Viewed

Tap Again To Close

Job Description

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, Experienced, 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 needed
  • Gather 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 determination
  • Provide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteria
  • Work 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 Manager
  • Recognize 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 team 
  • Support team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standards

Your Knowledge and Experience

  • Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) required
  • Advanced degree commensurate with field is preferred
  • Requires at least three (3) years of prior experience in healthcare related field
  • One (1) year conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment preferred
  • Strong 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 guidelines
  • Familiarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab results
  • Proficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databases 
  • Excellent analytical, communication skills, written skills, time management, and organizational skills 
  • Possess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiative
  • Ability to identify problems and works towards problem resolution independently, seeking guidance as needed
View Now

Behavioral Health Utilization Management Clinician, Experienced

94590 Mare Island, California Blue Shield of California

Posted today

Job Viewed

Tap Again To Close

Job Description

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, Experienced, 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 needed
  • Gather 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 determination
  • Provide information to facilities and providers regarding community treatment resources, mental health care management programs, company policies and procedures, and medical necessity criteria
  • Work 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 Manager
  • Recognize 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 team 
  • Support team through consistent and successful caseload management and workload to achieve team goals, regulatory timelines, and accreditation standards

Your Knowledge and Experience

  • Current unrestricted CA license (LCSW, LMFT, LPCC, PhD/PsyD or RN with Behavioral Health experience) required
  • Advanced degree commensurate with field is preferred
  • Requires at least three (3) years of prior experience in healthcare related field
  • One (1) year conducting Behavioral Health Utilization Management for a health insurance plan or managed care environment preferred
  • Strong 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 guidelines
  • Familiarity with medical terminology, diagnostic terms, and treatment modalities including ability to comprehend psychiatric evaluations, clinical notes, and lab results
  • Proficient with Microsoft Excel, Outlook, Word, Power Point, and the ability to learn and utilize multiple systems/databases 
  • Excellent analytical, communication skills, written skills, time management, and organizational skills 
  • Possess outstanding interpersonal, organizational, and communication skills, positive attitude, and high level of initiative
  • Ability to identify problems and works towards problem resolution independently, seeking guidance as needed
View Now
 

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