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

$10,161 - $82,812/Yr

Oregon Health Authority - Salem, OR

Full-time - Mid Level

Salem, OR

Social Assistance

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 young adults are medically necessary and appropriate. The BHCRC also collaborates on policy development to support the health needs of OHP recipients, with a commitment to health equity and service excellence.

Responsibilities

• Provide comprehensive clinical consultation regarding behavioral health conditions and treatment options covered under the Oregon Health Plan (OHP).
• Assist providers in determining coverage for alternative clinical treatments under the OHP.
• Review prior authorization requests for services, equipment, and supplies using clinical knowledge and experience.
• Interpret submitted clinical records to verify coverage of requested services, equipment, or supplies.
• Support the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program by identifying and approving necessary services for members under 21 years.
• Approve benefit coverage of services by exception when deemed medically necessary.
• Collaborate on agency rule, policy, and guidance development to support the health needs of OHP recipients.

Requirements

• A combination of experience or education equivalent to eight years of professional-level evaluative, analytical, and planning work.
• A degree in Business or Public Administration, Behavioral or Social Sciences, or a related field can substitute for some required experience.

Nice-to-haves

• Active clinical Oregon licensure through relevant licensing boards.
• Experience in developing and implementing policies and programs.
• Knowledge of health services delivery systems and government health benefit programs, particularly Medicaid.
• Understanding of Oregon's Behavioral Health System and key partners in the community.
• Clinical experience working with children and youth across various levels of care.

Benefits

• Exceptional medical, vision, and dental benefits packages.
• 11 paid holidays each year.
• 3 additional paid "Personal Business Days" each year.
• 8 hours of paid sick leave accumulated every month.
• 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.