Behavioral Health Specialist

State of Oklahoma

9d•$65,607•Onsite

About The Position

The Behavioral Health Specialist is responsible for evaluating the medical necessity, appropriateness, and quality of care for members receiving behavioral health services. This role involves conducting clinical record reviews, liaising with providers, and assessing member needs to ensure effective care delivery. By monitoring treatment progress, addressing barriers to care, and identifying necessary services, the specialist supports optimal health outcomes. Additionally, the position aims to foster collaborative relationships both within and outside the organization, contributing to the continuous improvement of behavioral health services in alignment with the Oklahoma Health Care Authority’s mission to provide better health and care for Oklahomans.

Requirements

Current and valid license behavioral health license such as: Licensed Professional Counselor (LPC) or Licensed Clinical Social Worker (LCSW), or Licensed Marriage and Family Therapist (LMFT) in the state of Oklahoma AND A master’s degree in psychology, counseling, human relations, clinical/direct practice social work, or a closely related field which must have included one semester of at least three hundred hours of applied clinical practicum in psychology or counseling plus one year post-master’s experience providing professional counseling services.
In-depth knowledge of clinical and behavioral health practices, state and federal healthcare policies, and program administration.
Key skills include the ability to evaluate care quality, communicate effectively with providers, and coordinate services across various stakeholders.
The role aligns with the Decision Quality and Collaborates Korn Ferry competencies, as it requires sound clinical decision-making and strong collaboration with internal and external partners to ensure optimal care delivery.
To be considered for this position your application must include a resume/CV with complete work and education history.

Nice To Haves

Certifications in any of the following areas: Certified Case Manager (CCM), Certified Addiction Specialist (CAS), Crisis Prevention and Intervention (CPI) Certification, or Project Management Professional (PMP)
SoonerCare experience
State or federal government work experience
Experience with an integrated healthcare delivery system
Experience in utilization management and/or inpatient psychiatric hospital position
Experience in care coordination/case management

Responsibilities

Evaluate medical necessity, care appropriateness, and quality through clinical record analysis and provider communication.
Distinguish between convenience and necessity ensuring clear and professional communication with providers.
Monitor treatment progress and engagement, assessing ongoing member needs through regular contact with involved parties.
Link members to necessary services by identifying treatment needs and available resources.
Identify and address barriers to provider participation and member access, offering recommendations for policy improvement.
Address issues affecting member participation and access to services.
Cultivate effective relationships within and outside the organization to fulfill responsibilities effectively.
Foster partnerships internally and externally to optimize member support.
Optimize member care delivery through integrated management of pre-approvals, quality control, and care coordination activities.
Other duties as assigned.