Behavioral Health Utilization Management Medical Case Manager

CalOptima Foundation

Orange, CA, US
Base: $90,820 - $145,312; bonus/equity: not specif...
On-site
Behavioral health utilization management experience
Clinical review of medical necessity
Prior authorization and concurrent review processes
The organization is a mission-driven community-based entity dedicated to serving member health with excellence and dignity

Job Summary

  • The organization is a mission-driven community-based entity dedicated to serving member health with excellence and dignity.
  • This role involves reviewing and processing authorization requests for behavioral health services while utilizing established clinical protocols to determine medical necessity.
  • Candidates will enjoy competitive compensation ranging from $90,820 to $145,312 along with a comprehensive benefits package including CalPERS pension and tuition reimbursement.

Matching Summary

The organization is a mission-driven community-based entity dedicated to serving member health with excellence and dignity.

Salary

Base: $90,820 - $145,312; Bonus/Equity: Not specified; Benefits: CalPERS pension, PTO, tuition reimbursement, wellness programs

Skills & Requirements

Must-have

  • Behavioral health utilization management experience
  • Clinical review of medical necessity
  • Prior authorization and concurrent review processes
  • ICD-10 CPT-4 HCPCS code accuracy verification
  • Provider and facility communication

Nice-to-have

  • Managed care industry background
  • Strong rapport building skills
  • Flexible schedule availability
  • Project management capabilities
  • Mission-driven culture alignment

Key Requirements

  • Current California unrestricted license (LCSW, LPCC, LMFT, or RN)
  • Minimum 3 years of clinical experience required
  • Utilization management reviewer experience preferred
  • Behavioral health clinical experience preferred

Work Rights

Must be authorized to work in California

Tailored Resume

Cover Letter