Behavioral Health Specialist {170339}

Behavioral Health Navigator – Onsite (California)
Location: Onsite (California — exact site provided during interview)
Schedule: Monday–Friday, 8:00 AM–5:00 PM

Pay: $43.50/hr
Job Type: Full Time

We’re hiring a Behavioral Health Navigator to support a busy Health Care Services team focused on Behavioral Health and Applied Behavioral Analysis (ABA). This Behavioral Health Navigator role is ideal for someone with managed care or healthcare operations experience who can manage prior authorizations, utilization management (UM) workflows, documentation, and member/provider communication with accuracy and urgency. If you’re detail-oriented, organized, and comfortable working across multiple systems and stakeholders, this is a strong opportunity to build behavioral health UM and care coordination experience.

Responsibilities (Behavioral Health Navigator):

• Process and monitor prior authorizations and corresponding documentation (pre-service, concurrent, urgent, routine, and retrospective)
• Maintain and prioritize authorization queues; monitor daily aging and turnaround-time (TAT) reports to meet service standards
• Use established UM guidelines/pathways to screen, authorize, and finalize inpatient/outpatient/retrospective requests
• Provide administrative support to behavioral health clinicians and nurses (UM and basic case management support)
• Coordinate timely member access to appropriate behavioral health services; work closely with Member Services
• Communicate with providers, hospitals, vendors, delegated groups, and community mental health entities to support care coordination
• Respond to provider/member/internal inquiries related to eligibility, benefits, authorizations, appeals, and behavioral health services
• Clarify member status, needs, and goals; identify barriers, resolve conflicts, and help adjust service plans with clinical staff
• Document actions accurately; perform high-volume data entry and written follow-up across multiple platforms
• Prepare reports for internal, regulatory, contractual, and accreditation requirements; support non-clinical audits and compliance reporting
• Participate in team meetings, process improvements, and special projects as assigned

Qualifications:

• Bachelor’s degree (health services or related preferred) or equivalent relevant experience
• 1+ year experience in healthcare, health plan, or managed care preferred (UM, prior auth, referrals, care coordination, claims/eligibility support)
• Strong verbal/written communication and professional phone skills
• Ability to work within protocols, exercise sound judgment, and manage competing priorities
• Proficiency with Microsoft Office (Excel, Outlook, Word) and comfort working in multiple systems/queues
• Experience with complex patient populations and behavioral health environments preferred
• Knowledge of California Children’s Services (CCS) is a plus

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