Behavioral Health - Behavioral Health Clinical Specialist 150-2007

Tulsa, OK, USA Req #577
Tuesday, June 25, 2024

JOB SUMMARY:

The Behavioral Health Clinical Specialist is an essential part of our behavioral health team and organization. This clinician will be instrumental in ensuring the appropriate utilization of behavioral health services for our members while upholding the highest standards of care and efficiency. This clinician will be responsible for clinical review and assessment of care for mental health and substance abuse services for the health plan. As well as monitoring and making level of care and service determinations for mental health and substance abuse requests. They will also provide support to members and front-line staff for urgent clinical matters.

 

KEY RESPONSIBILITIES:

  • Conduct utilization management activities (i.e. initial and concurrent clinical reviews) assess, certify, and refer members for behavioral health services and conducts ongoing dialogue with providers related to appropriate managed care handling of the case needs.
  • Communicate with members, providers, and internal stakeholders to gather necessary information for utilization review decisions and ensure timely authorization of services.
  • Monitor members' progress throughout the course of treatment, conducting ongoing reviews to assess effectiveness and make recommendations for adjustments as needed.
  • Document all utilization review activities accurately and thoroughly, maintaining compliance with regulatory requirements and health insurance company policies.
  • Conducts provider clinical chart audits and provider trainings as needed.
  • Participate in interdisciplinary team meetings, case conferences, and quality improvement initiatives to enhance the delivery of behavioral health services and member outcomes.
  • Stay informed about changes in healthcare regulations, clinical best practices, and industry trends to support informed decision-making and continuous improvement efforts.
  • Uphold the highest standards of ethics, professionalism, and confidentiality in all interactions with members, providers, and colleagues.
  • Performs other job duties as assigned.

 

QUALIFICATIONS:

  • Ability to review mental health and substance abuse cases and refer to appropriate levels of care rapidly and effectively.
  • Skilled in problem-solving and critical thinking.
  • Ability to effectively communicate with providers, office staff, coworkers, and members.
  • Excellent communication, interpersonal, and organizational skills.
  • Ability to work independently and collaboratively in a fast-paced environment with competing priorities.
  • Proficiency with Microsoft applications.
  • Successful completion of Health Care Sanctions background check.
  • Ability to converse and write fluently in English

 

EDUCATION/EXPERIENCE:

  • Master’s degree in a mental health field.
  • Active, unrestricted license to practice as a mental health professional in the State of Oklahoma.
  • At least four years of related clinical experience in mental health.
  • Managed behavioral health and/or utilization review experience preferred.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

 

Other details

  • Job Family Commercial
  • Pay Type Salary
Location on Google Maps
  • Tulsa, OK, USA