Behavioral Health Specialist

About the role

The Behavioral Health Specialist evaluates 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.

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.
• Maintain 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.

Requirements

• In-depth knowledge of clinical and behavioral health practices, state and federal healthcare policies, and program administration.
• Ability to evaluate care quality, communicate effectively with providers, and coordinate services across various stakeholders.
• Prior Authorization – Provide clinical determinations for prior authorizations including inpatient psychiatric treatment, electroconvulsive therapy (ECT), and therapeutic foster care (TFC).
• Ambulatory Behavioral Analysis (ABA) – Provide clinical determinations for applied behavioral analysis, ensuring authorization requests meet medical necessity criteria, benefit plan requirements, and regulatory standards.
• Service Quality Review – Evaluate the quality, appropriateness, and effectiveness of inpatient psychiatric services, applied behavioral analysis, and Residential Substance Use Disorder treatment.

Qualifications

• Current and valid behavioral health licenses such as: Licensed Professional Counselor (LPC) or Licensed Clinical Social Worker (LCSW), or Licensed Marriage and Family Therapist (LMFT), Board Certified Behavior Analyst (BCBA), and a master’s degree in psychology, counseling, human relations, clinical/direct practice social work, or a closely related field.
• 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.
• Preference qualifications include Certifications in any of the following areas: Certified Case Manager (CCM), Certified Addiction Specialist (CAS), or Crisis Prevention and Intervention (CPI) Certification.

Skills

The Behavioral Health Specialist position requires key skills including the ability to evaluate care quality, communicate effectively with providers, and coordinate services across various stakeholders.

Benefits

• Generous state-paid benefit allowance to offset insurance premiums.
• A wide selection of insurance plans with no pre-existing condition exclusions.
• Flexible Spending Accounts for health care and dependent care.
• Retirement Savings Plan with employer contributions.
• 11 paid holidays annually.
• 15 days of vacation and 15 days of sick leave in the first year.
• Longevity Bonus recognizing years of public service.
• Public Service Loan Forgiveness eligibility and tuition reimbursement.
• Wellness benefits, including an on-site gym and fitness center discounts.

Pay

$65,607.00/annual

Schedule

Monday – Friday
Primary Hours: 8:00 a.m. – 5:00 p.m.