Operations Specialist, Associate

Your Role 

The Behavioral Health Utilization Management team provides Utilization Management and Care Coordination for Promise Blue Shield members seeking BHT services. The Operations Specialist, Associate will report to the Sr. Manager of Behavioral Health Utilization Management. In this role you will assist with audit preparedness, act as a Behavioral Health subject matter expert (SME) for Utilization Management and Care Coordination/Management systems development and testing, and contribute to the development of tools, processes, and frameworks that advance best practices and deliver successful utilization management of behavioral health services.  

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: 

• Act as subject matter expert and review operational workflows, identifying problems and acting as a SME to inform improvements, modifications, and enhancements  
•  Track and communicate workflow and system changes to appropriate resources 
•  Review systems and applications and recommend system edits/changes as needed 
•  Notify appropriate department managers about issues and problems in operational workflow requiring immediate attention 
• Participate as a subject matter expert to inform the development of written guidelines and documents problems as needed 
• Assist with audit readiness including file preparation and risk assessment 
• Conduct system testing for Utilization Management and Care Management
• Support department oversight and daily operations through report and system review; providing validation and escalating issues to leadership as needed

Your Knowledge and Experience 

• Requires a bachelor’s degree; or high school (GED) and 4 years relevant experience
• 0 years of prior relevant experience required if bachelor’s degree
• 4 years of prior relevant experience if high school or GED 
• Requires health plan (managed care, government payer, academic) or healthcare experience (working for a provider)
• Foundational understanding of managed care utilization management, preferred
• Experience with writing workflows and processing documentation, preferred
• Ability to work independently
• Strong critical thinking skills with attention to detail
• Strong verbal and written communication skills

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.