Children’s Behavioral Health Clinical Review Coordinator (Medical Review Coordinator)
Do you have experience developing, implementing, and providing oversight of policies and programs at the community, state, and/or national level that promote equity and inclusion and reduce disparities? Are you passionate about ensuring equitable access and high quality health care services and supports for children and youth, and the providers who serve them? We look forward to hearing from you!
What you will do!
The Children’s Behavioral Health Medical Review Coordinator (BHMRC) 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 BHMRC 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 BHMRC 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 BHMRC 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 BHMRC 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.
Early and Periodic Screening, Diagnostic & Treatment (EPSDT) is a federally mandated Medicaid program which covers more than one-third of Oregon Health Plan members (approximately 500,000 children and youth under age 21). Starting in 2025, the program will begin to extend EPSDT benefits to young adults with special health care needs (YSHCN) up to 26 years of age, as well as provide certain benefits to youth while incarcerated. This position will work as a member of the Early Periodic Screening Diagnosis and Treatment (EPSDT) team and collaborate closely with Oregon Health Authority’s (OHA) External Relations Division and communication contractors.
What's in it for you?
The public health division 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 are committed to racial equity as a driving factor to improve health outcomes for all communities that experience inequities.
- We offer exceptional medical, vision and dental benefits packages for you and your qualified family members, with very low monthly out-of-pocket costs. Try this free virtual benefits counselor by clicking here: https://www.oregon.gov/oha/pebb/pages/alex.aspx
- 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.
- Click here to learn more about State of Oregon benefits.
OHA values health equity, service excellence, integrity, leadership, partnership, innovation and transparency. OHA’s health equity definition is “Oregon will have established a health system that creates health equity when all people can reach their full potential and well-being and are not disadvantaged by their race, ethnicity, language, disability, age, gender, gender identity, sexual orientation, social class, intersections among these communities or identities, or other socially determined circumstances. Achieving health equity requires the ongoing collaboration of all regions and sectors of the state, including tribal governments to address: the equitable distribution or redistributing of resources and power; and recognizing, reconciling, and rectifying historical and contemporary injustices.” OHA’s 10-year goal is to eliminate health inequities. Click here, to learn more about OHA’s mission, vision and core values.
WHAT WE ARE LOOKING FOR:
A current Registered Professional Nurse license issued by the Oregon State Board of Nursing at the time of appointment and maintained throughout employment AND three years of nursing experience that includes review of medical records.
- Preference may be given for the ability to read, write, speak and interpret English and one of the 5 most common languages in Oregon other than English (Spanish, Vietnamese, Chinese, Russian, and Korean) with full proficiency in a culturally humble manner.
- 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/facilitating 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 in collaborating with diverse populations most harmed by social injustice and inequities; demonstrated ability to build and steward positive relationships with diverse community groups including communities of color, immigrant groups, the disability and neurodivergent communities, veterans, older adults, individuals identifying as LGBTQIA2S+ and other communities that have been traditionally marginalized.
- Specific knowledge of Oregon Administrative Rules and Oregon Revised Statutes, other applicable regulations, and program requirements.
- Knowledge of health services delivery systems, particularly the Oregon Health Plan/State Medicaid Administration, and experience in working with Community Mental Health Programs, Behavioral Health Service Providers, Coordinated Care Organizations or other managed care entities.
- Clinical experience with a broad spectrum of evidence-based health care standard practices.
- Experience working across multiple levels within the behavioral health continuum of care, i.e. outpatient, and/or acute, and/or residential; specific experience with children and youth preferred.
- 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.
- Ability to demonstrate advanced Microsoft Excel, Word, PowerPoint, and Outlook skillset; and skilled use of collaboration tools such as Microsoft Teams, SharePoint, and Smartsheet.
- Ability to provide organizational leadership to support inter-and cross-agency collaboration and systems-wide changes that facilitate advocacy, equity, and client-centered policies and solutions.
- 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.
How to apply:
Complete the online application at oregonjobs.org using job number REQ-148822
Application Deadline 02/19/2024