Program Manager, Consultant

Your Role

The Network Management team is responsible for the development and maintenance of all provider networks, including vendor and Plan to Plan relationships necessary to provide our members and clients with access to quality, affordable health care services. The Program Manager, Consultant will report to the Senior Manager, Behavioral Health Provider Contracting. In this role you will support the Blue Shield of Californias Behavioral Health Program.

Your Knowledge and Experience

• Requires a bachelors degree or equivalent experience. Masters degree or clinical licenses is preferred
• Requires 7 years of experience in the related area
• Behavioral Health managed care experience. At least 5 years is preferred
• Experience in managed care Behavioral Health claims analysis/investigations
• Experience with regulatory Behavioral Health claims audits
• Experience researching Behavioral Health claims for overpayments and fraud
• Understanding fundamentals of Behavioral Health Provider contracts