Initial Posting Date: 10/15/2024
Application Deadline: 10/29/2024
Agency: Oregon Health Authority
Salary Range: $6,901 - $10,161
Position Type: Employee
Position Title: Children’s Behavioral Health Clinical Review Coordinator (Operations & Policy Analyst 4)
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.
The OHA mission is helping people and communities achieve optimum physical, mental, and social well-being through partnership, prevention and access to quality, affordable health care. OHA’s work is organized into three broad goals: Improve the lifelong health of all Oregonians, increase the quality, reliability, and availability of care for all Oregonians and lower or contain the cost of care so it is affordable to everyone.
What's in it for you?
Oregon Health Authority is a team of passionate individuals working to promote health across the lifespan of individuals, families, and communities. We value and support unique perspectives using a trauma-informed approach and aim to reflect these values in our hiring practices, professional development, and workplace.
- We offer exceptional medical, vision and dental benefits packages for you and your qualified family members, with very low monthly out-of-pocket costs.
- 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.
WHAT WE ARE LOOKING FOR:
Minimum Qualifications
Any combination of experience or education equivalent to eight years of experience professional-level evaluative, analytical and planning work.
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.
- Experience in advancing health equity, including effective delivery of culturally responsive and inclusive services, evidence of ongoing development of personal cultural awareness and humility, and knowledge of social determinants of health and their impacts on health outcomes.
- Experience supporting the development and implementation of policies and programs at the community, state, and/or national level that promote equity and inclusion and address systemic health disparities, with an emphasis on integrating the voice of consumers with lived experience.
- Experience factoring in the perspectives of diverse populations most harmed by social injustice and inequities including communities of color, immigrant groups, the disability and neurodivergent communities, veterans, older adults, individuals identifying as LGBTQIA+ and other communities that have been traditionally marginalized.
- 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 applying clinical knowledge drawn from a broad education in the social and clinical sciences to recognize the most effective, clinically appropriate health care services necessary to promote a person's optimum health and well-being.
- Experience with individual patient advocacy and supporting the acquisition of medically necessary health services.
- Strong communication skills across a variety of forms that demonstrate the ability to facilitate appreciative inquiry, foster trust and transparency, and promote human-centered change management.
- Experience communicating qualitative and quantitative information, verbal and written, that are accessible to and understood by audiences with different levels of comprehension or interest and that are culturally responsive, inclusive, and appropriate.
- Ability to navigate complex relationships; ability to demonstrate collaborative problem-solving skills, consensus-building and solution driven approaches.
- Ability to demonstrate skilled use of collaboration tools such as Microsoft Teams, SharePoint, and Smartsheet.
How to apply:
- Complete the online application
- Attach a Cover Letter, no more than 2 pages, specifically focused on your qualifications for this position as identified in the Desired Attributes section of this announcement.
- Please ensure you’ve provided a thorough and updated application as it pertains to the position for which you are applying. Update professional, educational, voluntary, and personal experience on your resume. Your application materials will be used to determine salary based on a pay equity assessment. For further information, please visit the Pay Equity Project homepage.
Questions/Need Help?
If you need assistance to participate in the application process, including an accommodation request under the American with Disabilities Act contact: Stephanie Mitchell at Voice: [503-979-7679] (TTY 711) or Email: stephanie.d.mitchell@oha.oregon.gov.
TTY users may dial 711 or 1-800-735-2900.
For Workday technical support dial 1-855-524-5627.
Additional Information
- Please monitor your Workday account, as all communication will be sent to your Workday account. You must have a valid e-mail address to apply.
- Candidates gathered from this job announcement may be used to fill future vacancies.
- If you are a veteran, you may receive preference. Click here for more information about veterans’ preference. If you checked that you are a veteran, we will ask you for your documents later in the process.
- Oregon Health Authority (OHA) does not offer VISA sponsorship. Within three days of hire, you will be required to complete the US Department of Homeland Security’s I-9 form confirming authorization to work in the United States. OHA is an E-Verify employer and will use E-Verify to confirm that hires are authorized to work in the United States.
- If you are offered employment, the offer will be contingent upon the outcome of an abuse check, criminal records check and driving records check, and the information shall be shared with the Oregon Health Authority (OHA), Office of Human Resources (OHR). Any criminal or founded abuse history will be reviewed and could result in the withdrawal of the offer or termination of employment.
- Please only attach documents that are related to the position. Additional documents that are attached will not be reviewed.
- Attention current State of Oregon employees: To apply for posted positions, please close this window and log into your Workday account and apply through the Career worklet.
- Applicant Help and Support webpage
The Oregon Health Authority is committed to fair employment practices and non-discrimination, including pay equity for all employees. We do not discriminate on the basis of protected class (race, sex, veteran status, disability, age, color, religion, national origin, marital status, sexual orientation) in the payment of wages or screen applicants on the basis of their current or past compensation. We determine salary by completing a review of your application materials to evaluate your related education, experience, and training for this position.
The Oregon Health Authority is an equal opportunity, affirmative action employer committed to work force diversity and anti-racism.
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