Childrens Behavioral Health Clinical Review Coordinator (Operations & Policy Analyst 4)

$10,161 - $82,812/Yr

Oregon.gov

Full-time - Mid Level

About the position

The Children's Behavioral Health Clinical Review Coordinator (BHCRC) plays a crucial role in providing clinical consultation regarding behavioral health conditions and treatment options covered under the Oregon Health Plan (OHP). This position involves reviewing prior authorization requests, interpreting clinical records, and ensuring that services for children and youth are medically necessary and appropriate. The BHCRC also collaborates on policy development to support the health needs of OHP recipients, with a strong emphasis on health equity and community engagement.

Responsibilities

• Provide comprehensive clinical consultation on behavioral health conditions and treatment options covered under the Oregon Health Plan (OHP).
• Review prior authorization requests for services, equipment, and supplies, ensuring they meet OHP coverage criteria.
• Support the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program by identifying and approving necessary services for members under 21.
• Collaborate on agency rule, policy, and guidance development to ensure alignment with health needs of OHP recipients.
• Interpret Oregon Administrative Rules and Health Evidence Review Commission guidelines to establish OHP benefits baseline.

Requirements

• A combination of experience or education equivalent to eight years of professional-level evaluative, analytical, and planning work.
• Active clinical Oregon licensure through relevant licensing boards (e.g., Medical Board, Social Workers Board, Nursing Licenses).
• Experience in advancing health equity and delivering culturally responsive services.
• Knowledge of health services delivery systems and government health benefit programs, particularly Medicaid.
• Clinical experience working across the behavioral health continuum of care, especially with children and youth.

Nice-to-haves

• Experience in policy and program development at community, state, or national levels.
• Knowledge of Oregon's Behavioral Health System and key partners.
• Experience with individual patient advocacy and supporting acquisition of medically necessary health services.
• Strong communication skills for diverse audiences.

Benefits

• Exceptional medical, vision, and dental benefits with low out-of-pocket costs.
• 11 paid holidays each year.
• 3 additional paid Personal Business Days each year.
• 8 hours of paid sick leave accumulated monthly.
• Progressive vacation leave accrual with increases every 5 years.
• Pension and retirement programs.
• Optional benefits including short-term and long-term disability, deferred compensation savings program, and flexible spending accounts.