Behavioral Health Specialist (Hybrid Work Schedule)

Position Summary/Position

Under the direction of the Behavioral Health Supervisor, the Behavioral Health Specialist is a high volume, fast paced position that required the coordinator and timely processing of authorizations request, coordinates Behavioral Health services for Members, conducts Behavioral Health clinical screenings, and utilization review of Behavioral Health authorization requests. The Behavioral Health Specialist position requires basic understanding of mental health disorders in order to determine appropriate level of care for Members and interface with Providers regarding treatment planning of Members.

This is a Bilingual (English/Spanish) position. The Team Member in this role must take a language proficiency assessment and must receive a passing score.

Major Functions (Duties and Responsibilities)

1. Monitors and processes incoming (inpatient and outpatient) Behavioral Health requests in the Medical Management System in an accurate and timely manner to ensure compliance with appropriate turnaround time frames as established by regulatory guidelines.
2. Processes Primary Care Physician requests by reviewing the requested services and authorizing or making clinical recommendations for a denial of service to licensed clinical staff. 
3. Processes professional and institutional claims as assigned by Supervisor.
4. Assists with Level 1- Behavioral Health quality assurance check for professional service requests.
5. Conducts utilization review of Coordination of Care/Discharge Summary Web Forms, which may require linking Members to additional resources based on Provider recommendations and Members clinical presentation.
6. Runs daily Behavioral Health Service Request canned reports to ensure that all pending authorizations are completed in accordance with regulatory guidelines.
7. Communicates with Providers regarding authorizations and other matters pertinent to processing authorization requests.
8. Facilitates member care to ensure that continuity of care is executed appropriately.
9. Conducts Behavioral Health screening in order to make necessary referrals based on Member’s presenting symptoms.
10. Assists in the assessment of potential crisis and disruptive callers by working closely with Behavioral Health Care Managers and Management to properly deescalate calls and address Member needs. 
11. Completes assigned Behavioral Health follow ups from other departments including Behavioral Health Providers; this may require developing Problem, Goals and/or Interventions in the Members Care Plan and close collaboration with the Care Management department.
12. Assists Behavioral Health phone queue as requested and/or scheduled. This includes, but is not limited to, answering Member/Provider calls in a friendly and professional manner.

Major Functions (Duties and Responsibilities) Cont

Supervisory Responsibilities

Experience Qualifications

Bilingual (English/Spanish) - written and verbal skills required.

Three (3) years experience performing consumer-directed services in a Behavioral Health care setting required.

Preferred Experience

Utilization Management experience, including referral process, DSM, ICD-10 and CPT codes preferred (requirement may be substituted with applicable experience in a hospital, IPA or medical clinic environment).

Education Qualifications

Bachelor's degree from an accredited institution required.

Preferred Education

Bachelor's degree preferably in Social Work or related field from an accredited institution.

Professional Certification

Professional Licenses

Drivers License Required

Knowledge Requirement

Knowledge of Medi-Cal, Healthy Kids and Medicare required.  Knowledge of Behavioral Health principles and familiarity with the DSM-5. General understanding of co-morbid medical/Behavioral Health conditions. Knowledge of utilization review processes and care coordination in HMO or Managed Care setting preferred. Understanding of and sensitivity to multi-cultural community.

Skills Requirement

Demonstrated proficiency in Microsoft Office applications (Word, Excel, Access, Outlook, etc.) Must have excellent written and verbal communication and interpersonal skills. Strong critical thinking and organizational skills. Demonstrated problem-solving skills.

Abilities Requirement

Ability to communicate and work effectively with a variety of providers and individuals with demonstrated problem-solving skills. High degree of patience.

Commitment to Team Culture

The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization.

Working Conditions

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; and taste or smell. The employee must occasionally lift or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Position is eligible for telecommuting/remote work location model upon completing the necessary steps and receiving HR approval. The incumbent approved to telecommute may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs determined by IEHP leadership.

Work Model Location

Physical Requirements