Behavioral Health Specialist

Agency/Division Information:  

The Oklahoma Health Care Authority (OHCA) works to ensure Oklahomans have access to better health and better care. The agency’s core values include passion for purpose, trust and transparency, empowerment and accountability, best in class and outcome-driven, and servant leadership. As part of the interview process, candidates may be required to attend an in-person interview at our Oklahoma City office.  

Position Purpose:  

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. 

Principal Activities May Include:  

• 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.  

Knowledge, Skills, Abilities and Competency Requirements: 

The Behavioral Health Specialist position requires 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.**

Education and/or Experience:  

• 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.  

Preference Qualifications Include:  

• 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 

Physical Demands and Work Environment:

Work is typically performed in an office setting with climate-controlled settings and exposure to moderate noise levels. In the course of performing job duties, employees are required to speak, stand, walk, and reach with their hands and arms. This position requires extended periods of sitting and daily use of computers and phones. Employees must be willing to complete all job-related travel associated with this position. Being present at the office is an essential function of this position.  

Accommodation Statement: 

The Oklahoma Health Care Authority complies with applicable State and Federal civil rights laws and does not discriminate.  All qualified applicants will receive consideration for employment without regard to race, color, sex, religion, disability, age, national origin, or genetic information. If a reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the Civil Rights Coordinator at 405-522-7335.