Operations Specialist, Experienced (BH Utilization Management)

Company: Blue Shield of California
Location: El Dorado Hills
Posted on: July 13, 2025

Job Description:

Your Role The Behavioral Health (BH) Utilization Management (UM) team manages prior authorization and concurrent review for members seeking mental health and/or substance use disorder treatment. The Operations Specialist, Experienced will report to the Sr. Manager, BH UM. In this role you will be the subject matter expert for the BH UM team with projects and deliverables that support business needs for our Fully Insured products. Your Work In this role, you will: Act as a subject matter expert to review operational workflows of high degree of complexity, identifying problems and developing improvements, modifications, and enhancements Work with business leaders to identify requirements and make recommendations Develop and evaluate tools and materials that enhance operating efficiency, accuracy, and technical skill levels of unit staff May be responsible for entire projects or processes within job area Track and communicate workflow and system changes to appropriate sources and coordination of training and documentation needs Notifies appropriate managers on issues and problems requiring immediate attention and provides recommendations for resolution Responsible for improving processes to enhance performance of the job area Develop and generate reports ranging from routine to moderately complex for management review Identify and implement process enhancements and efficiency gains that can be realized on an ongoing basis Support testing to ensure system functionality Maintain ongoing relationships with vendor partners to ensure compliance with regulations, SLAs and performance Your Knowledge and Experience Requires practical knowledge of Utilization Management functions including prior authorization/concurrent review Requires a college degree or equivalent experience Requires 3 years of prior relevant experience Understanding of behavioral health facility-based levels of care preferred Experience with Prior Authorization preferred Experience working with project management and business change readiness preferred Strong written and verbal communication skills Strong critical thinking skills and attention to detail

Keywords: Blue Shield of California, Daly City , Operations Specialist, Experienced (BH Utilization Management), IT / Software / Systems , El Dorado Hills, California