Job Description

Do you have an interest in helping Oregonians in need by assisting Providers with health service authorization requests? Do you have experience using clinical knowledge and experience to support and respond to the needs of children, youth, and young adults navigating complex health needs? We look forward to hearing from you!

This posting will be used to fill one (1) permanent, full-time position. This position is classified as Management Service and is not represented by a union.

Work Location: Salem/Marion or Portland/Multnomah; hybrid position

What you will do!

The Children’s Behavioral Health Clinical Review Coordinator (BHCRC) provides comprehensive clinical professional consultation regarding which behavioral health condition and clinical treatment combinations are covered under the Oregon Health Plan (OHP) and assists providers in determining if and which alternative clinical treatments would be covered by the OHP. The BHCRC references Oregon Administrative Rules and Health Evidence Review Commission guideline notes to establish a consistent baseline of OHP benefits when addressing requests for OHP coverage of health services. In addition, the BHCRC is responsible for reviewing prior authorization requests for services, equipment, and supplies, using their clinical knowledge and experience to interpret submitted clinical records to verify that the services, equipment, or supplies being requested are covered by the OHP. The BHCRC is also responsible for supporting the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program by identifying and approving medically necessary and medically appropriate services for members younger than 21 years. In addition, the BHCRC identifies occurrences where it is appropriate to approve benefit coverage of other services, equipment, or supplies by exception to existing agency guidance when they are deemed medically necessary, medically appropriate as well to collaborate on agency rule, policy, and guidance development to ensure that guidance supports the health needs of OHP recipients.

OHA values service excellence, leadership, integrity, health equity and partnership and has a strategic goal to end all health inequities by 2030.

What’s in it for you?

• Salary Range: $6,901 – $10,161
• We offer exceptional medical, vision and dental benefits packages for you. https://www.oregon.gov/oha/pebb/pages/alex.aspx
• Paid Leave Days:
  • 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 include short-term disability, long-term disability, deferred compensation savings program, and flexible spending accounts for health care and childcare expenses.
• Click here to learn more about State of Oregon benefits.

WHAT WE ARE LOOKING FOR:

Minimum Qualifications

Any combination of experience or education equivalent to eight years of experience coordinating or administering a program.

NOTE:

A degree in Business or Public Administration, Behavioral or Social Sciences, or a degree related to the agency program will substitute for some required experience:

• An Associate’s Degree is equal to 18 months of experience.
• A Bachelor’s Degree is equal to three years of experience.
• A Master’s Degree is equal to four years of experience.
• A Doctorate Degree is equal to five years of experience.

Desired Attributes

• Active clinical Oregon licensure through one of following licensing boards: The Oregon Medical Board, The Board of Licensed Social Workers, The Oregon Board of Licensed Councelors and Therapists, The Oregon State Board of Nursing Licenses, or The Health Related Licensing Boards.

• Specific knowledge of health services delivery systems; government health benefit programs, particularly Medicaid; and client rights related to those programs.
• Knowledge of Oregon’s Behavioral Health System and relational landscape of key partners, providers, community based organizations, and advocacy groups.
• Knowledge and understanding of the full continuum of behavioral health care, with specific understanding of the cross section between behavioral health, community corrections and systemic racism.

• Specific knowledge and experience referencing and applying Oregon Administrative Rules and Oregon Revised Statutes, other applicable regulations, and program requirements.

• Clinical experience working across multiple levels within the behavioral health continuum of care including with children and youth, i.e. outpatient, and/or acute, and/or residential.
• Experience with individual patient advocacy and supporting the acquisition of medically necessary health services.

• Experience communicating qualitative and quantitative information, verbal and written.

How to Apply

Job Categories: Equal Opportunities. Job Types: Full-Time. Salaries: 80,000 - 100,000.

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