Behavioral Health Clinical Specialist

2 weeks ago

Tulsa, Oklahoma, United States CommunityCare Full time
Job Summary:

The Behavioral Health Clinical Specialist is a vital member of our team at CommunityCare, responsible for ensuring the appropriate utilization of behavioral health services for our members while maintaining the highest standards of care and efficiency. This licensed clinician will be instrumental in reviewing and assessing care for mental health and substance abuse services, making level of care and service determinations, and providing support to members and front-line staff for urgent clinical matters.

Key Responsibilities:
  • Conduct utilization management activities, including initial and concurrent clinical reviews, to assess, certify, and refer members for behavioral health services.
  • 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.
  • Conduct 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.
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.

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