Behavioral Health Specialist

Recruitment #220516-X31A-47

Introduction

Position Requirements:
Under general direction of the Behavioral Health Operations Assistant Director or Manager this position is responsible for performance of the clinical review process as it relates to inpatient prior authorizations, therapeutic foster care prior authorizations and the care coordination process.  Also provides clinical analysis of services provided by psychiatric facilities and Therapeutic Foster Care agencies for quality of care.

PRINCIPLE ACTIVITIES: 
- Make determinations of medical necessity by review of clinical records and direct contact with providers as necessary. Distinguish between convenience and medical necessity and communicate these issues to providers clearly and professionally.
- Make determinations regarding the appropriateness and quality of care by review of clinical records and through direct contact with providers.
- Identify and research areas of behavioral health in order to maintain consistent application of policy and medical necessity criteria.
- Identify issues that affect provider participation and member access to providers, and offer recommendations to Behavioral Health Operations Assistant Director/Manager intended to promote policies and procedures that remove barriers to provider participation and lead to better access to care.
- Communicate agency policies and procedures to behavioral health providers and other clinicians as needed.
- Develop effective working relationships with the appropriate staff in other divisions, in order to fulfill responsibilities.
- Care manage inpatient cases throughout continuum of care including post discharge.
- Other duties as assigned.

TRAVEL:  Travel on an “as needed” basis.

Accommodation Statement:
The Oklahoma Health Care Authority complies with applicable Federal civil rights laws and does not discriminate.  All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335.

MINIMUM QUALIFICATIONS

KNOWLEDGE AND BACKGROUND REQUIREMENTS
QUALIFICATIONS
: To perform this job successfully, the individual must be able to perform each essential duty satisfactorily and autonomously.  The requirements listed below are representative of the knowledge, skills, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

EDUCATION AND/OR EXPERIENCE:
- A current valid license as a Social Worker (Clinical Specialty), Professional Counselor, Marriage and Family Therapist, Behavioral Practitioner, Alcohol and Drug Counselor, Psychologist, or other licensed behavioral health provider AND
- At least two years’ full-time professional experience in behavioral health related environment. OR
- Current/valid RN license AND
- At least two years’ full-time professional experience in behavioral health related environment.
- Working knowledge of HIPAA requirements.
- No substitution for the license requirement.

PREFERENCE MAY BE GIVEN TO CANDIDATES WITH:
- SoonerCare experience
- State or federal government work experience
- Experience with an integrated healthcare delivery system
- Experience in a utilization management and/or inpatient psychiatric hospital position.

NOTES

Please read instructions carefully and include all required documents when you submit your application.

No additional information will be accepted after the application has been submitted.