Program Manager, Consultant (Mental Health Parity Addiction Equity Act)

Job Description

Your Role

The Utilization Management team processes Medical and Behavioral Health prior authorization and concurrent review requests for BSC membership. The Program Manager, Consultant will report to the Sr. Manager Behavioral Health Utilization Management. In this role you will oversee and ensure Utilization Management compliance with federal and California State mental health parity requirements.

Responsibilities

Your Work

In this role, you will:
? Provide overall program leadership, guidance, and management of all aspects of the Utilization Management Mental Health Parity program
? Oversee the Utilization Management organization?s adherence to federal (CAA 203) and California (SB855) mental health parity mandates.
? Complete annual and off-cycle revisions to policies and procedures, desk level procedures, and provider manuals to align with regulatory requirements
? Conduct annual evaluation of CAA 203 factors to validate the application of prior authorization and concurrent review.
? Develop and present quarterly Mental Health Parity reports to the Utilization Management Committee
? Serve as the Utilization Management subject matter expert (SME) for mental health parity mandates and compliance
? Manage multiple vendor contracts for nonprofit association clinical guidelines and training
? Drive Utilization Management system enhancements to accommodate updated and/or new clinical guidelines
? Represent Utilization Management during internal and external mental health parity related audits and requests - inclusive of audit timeline management, documentation and data collection/review, audit response development, interviews and issue/gap resolution
? Lead cross-functional meetings and foster teamwork; drive escalation and resolution of issues, while promoting collaboration and coordination across broad categories of stakeholders

Qualifications

Your Knowledge and Experience
? Requires a bachelor?s degree or equivalent experience
? Requires at least 7 years of prior relevant experience
? Requires prior relevant experience in a managed care setting with knowledge of compliance and regulatory affairs
? In-depth knowledge of federal (CAA 203) and California state (SB855) Mental Health Parity laws
? Strong understanding of Behavioral Health Utilization Management
? Strong analytical skills, including the ability to interpret and determine the impact of complex laws, regulations and other documents
? The ability to independently achieve objectives and resolve issues under ambiguous circumstances
? Strong decision-making, organizational, planning, and problem-solving skills, and communication skills are needed to effectively interact with staff, team members and others in a professional and tactful manner.
? Strong presentation skills with the ability to tailor presentations to a specific audience, and address and interact with large groups preferred

Pay Range:

The pay range for this role is: $ 109120.00 to $ 163680.00 for California.

Note:

Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.

About The Team

Blue Shield of California?s mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our continued commitment to diversity, equity, and inclusion upholds our values and advances our goal of creating a healthcare system that is worthy of our family and friends while addressing health disparities, promoting social justice, and integrating health equity through our products, business practices, and presence as a corporate citizen.

Blue Shield has received awards and recognition for being a certified Fortune 100 Best Companies to Work, Military Friendly Employer, People Companies that Care, a Leading Disability Employer, and one of California?s top companies in volunteering and giving. Here at Blue Shield, we strive to make a positive change across our industry and communities ? join us!

Our Values:
? Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
? Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes.
? Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model:

At Blue Shield of California, we believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility. As we continue to evolve our workplace model, our focus remains on creating spaces where our people can connect with purpose ? whether working in the office or through a hybrid approach ? by providing clear expectations while respecting the diverse needs of our workforce.

Two Ways of Working:
? Hybrid (Default): Work from a business unit-approved office at least two (2) times per month (for roles below Director-level) or once per week (for Director-level roles and above).Exceptions:
? Member-facing and approved out-of-state roles remain remote.
? Employees living more than 50 miles from their assigned offices are expected to work with their managers on a plan for periodic office visits.
? For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.
? On-Site: Work from a business unit-approved office an average of four (4) or more days a week.

Physical Requirements:

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity:

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.

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