Pediatric Behavioral Therapy (PBT) Policy Specialist

State of Colorado; Denver (CO); Hybrid; USD 85,000 - 120,000; Full time

Benefits offered by this job

PERA benefits

Medical Insurance

Dental Insurance

Vision Insurance

Disability Coverage

Life Insurance

FSAs

Paid Holidays

Sick Leave

Flexplace & Flextime

RTD EcoPass

Tuition Assistance

Credit Union

Job summary

State Of Colorado is seeking a Pediatric Behavioral Therapy (PBT) Policy Specialist within the Health Policy Office. This role focuses on policy development, program administration, and statewide implementation of the PBT benefit, with emphasis on compliance and cost-effectiveness.

The position requires residency in Colorado and offers a hybrid work arrangement with in-office onboarding in downtown Denver. Eligibility for PERA and comprehensive State benefits is included.

Qualifications

• 7+ years of professional experience in behavioral health, psychology, social sciences, public health, health administration, public policy, or related field.
• Bachelor's degree plus 3+ years of experience in the same areas; education substitutes for experience per policy.
• Advanced degree can substitute for years of experience per state rules.

Responsibilities

• Serve as Staff Authority on PBT policy, researching and recommending policy solutions.
• Influence policy development, benefit administration, claims, provider communications, and program ops.
• Provide guidance to leadership and stakeholders regarding PBT policy requirements.
• Lead leadership and oversight of the PBT benefit, ensuring compliant claims processing and guidance.
• Manage projects to define scope, duration, and cost-effective service delivery for PBT.
• Draft State Plan language, amendments, and regulatory analyses related to PBT.
• Collaborate with divisions and external partners on reimbursement methodologies and policy changes.

Skills

Policy analysis

Regulatory compliance

Stakeholder communication

Cross-functional leadership

Data interpretation

Policy drafting

Project management

Education

Bachelor's degree in behavioral health or related field

Advanced degree in social sciences or related field

Job description

State Of Colorado Residency Required At Time Of Application

Note: This announcement may be used to fill multiple openings.

Envision Yourself Working at HCPF

The State of Colorado strives to create a Colorado for All by building and maintaining workplaces that value and respect all Coloradans through a commitment to equal opportunity and hiring based on merit and fitness. The State is resolute in non-discriminatory practices in everything we do, including hiring, employment, and advancement opportunities.

Department Information

State Of Colorado Residency Required At Time Of Application

Note: This announcement may be used to fill multiple openings.

Envision Yourself Working at HCPF

The State of Colorado strives to create a Colorado for All by building and maintaining workplaces that value and respect all Coloradans through a commitment to equal opportunity and hiring based on merit and fitness. The State is resolute in non-discriminatory practices in everything we do, including hiring, employment, and advancement opportunities.

The Department of Health Care Policy & Financing (HCPF) oversees and operates Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), and other state public health programs for qualified Coloradans. Our mission is to improve health care equity, access and outcomes for the people we serve while saving Coloradans money on health care and driving value for Colorado.

We are looking for a Pediatric Behavioral Therapy (PBT) Policy Specialist for the Policy & Benefits Delivery Systems Division of the Health Policy Office (HPO)! The Policy and Benefits Delivery Systems Division of HPO is responsible for the administration and performance of Medicaid acute care services and programs. The services and programs include both physical health and behavioral health. Staff within the Division are responsible for stakeholder relations, policy development and implementation, contract management and performance, program administration and overall Medicaid program performance. The Division plays an important role in working toward the Department of Health Care Policy and Financing’s (Department) mission to improve access to cost-effective, quality health care services for Coloradans.

We are committed to increasing the diversity of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of diverse backgrounds and abilities.

As part of the State of Colorado, HCPF offers a competitive benefits package:

• PERA retirement benefits including PERA Defined Benefit Plan, PERA Defined Contribution Plan, plus 401K and 457 plans
• Medical, Dental, and Vision insurance coverage
• Automatic Short-Term and Optional Long-Term Disability Coverage
• Life and AD&D Insurance
• Flexible Spending Accounts (FSAs)
• Family Medical Leave Act (FMLA) job protection and State of Colorado Paid Family Medical Leave (PFML)
• 11 Paid Holidays Annually and Accrued Annual and Sick Leave
• Accrued Sick Leave for State of Colorado Temporary Employees
• Flexplace and Flextime work arrangements
• Variety of discounts on services and products available through the State of Colorado's Work-Life Employment Discount Program
• Free RTD EcoPass to all eligible State Employees
• Reduced college tuition through CSU Global
• Credit Union of Colorado Membership Eligibility
• Some positions may qualify for the Public Service Loan Forgiveness Program. For more information, go to https://www.colorado.gov/pacific/dhr/student-loan-forgiveness-programs. https://dhr.colorado.gov/dhr-resources/student-loan-forgiveness-programs

We are onboarding new employees using a hybrid approach. The Department supports flexible work arrangements. Depending on the business need and description of the position, we have options that range from hybrid to full-time in the office. Specific discussions about the schedule will be discussed during the offer stage.

**Please note - equipment provisioning and certain onboarding tasks will take place in person, in our downtown Denver office, on the first day of employment.**

Description of Job

What You’ll Be Doing As PBT Policy Specialist

• Serve as the Department’s recognized Staff Authority on all matters related to the PBT benefit by researching, interpreting, developing, and recommending policy solutions concerning complex clinical, operational, regulatory, reimbursement, and programmatic issues.
• Directly influence Department-wide policy development, benefit administration, claims processing, provider communications, system configuration, program implementation, budget planning, and compliance activities.
• Provide authoritative guidance to executive leadership, program areas, fiscal staff, legal counsel, contractors, providers, advocacy organizations, and other internal and external stakeholders regarding PBT policy and program requirements.
• Provide strategic leadership, management, and oversight of the Pediatric Behavioral Therapy (PBT) benefit, ensuring claims processing, prior authorization requirements, provider guidance, and program operations comply with approved Medicaid policy, State Plan requirements, federal regulations, and the Colorado Code of Regulations.
• Lead complex projects and initiatives to define, evaluate, and modify the amount, scope, and duration of the PBT benefit to promote member access, quality outcomes, regulatory compliance, and cost-effective service delivery.
• Develop and maintain State Plan language and drafting State Plan Amendments, regulations, fiscal analyses, legislative analyses, provider billing guidance, and implementation plans related to the PBT benefit.
• Collaborate across divisions and with external partners to establish reimbursement methodologies, implement policy and operational changes, evaluate program performance, resolve complex policy issues, and ensure the effective administration of the PBT benefit statewide.

Residency Requirement

This posting is only open to residents of the State of Colorado at the time of submitting your application.

Class Code & Classification Description

H1R4XX Policy Advisor IV

Minimum Qualifications

There are two ways to qualify for this position:

Option 1

Experience Only:

Seven (7) total years of professional experience in behavioral health, psychology, social sciences, public health, health administration, public policy, or a closely related field.

Option 2

<

Education and Experience:

Bachelor's degree from an accredited institution in behavioral health, psychology, social sciences, public health, health administration, public policy, social work, or a closely related field

AND

Three (3) total years of professional experience in behavioral health, psychology, social sciences, public health, health administration, public policy, or a closely related field.

Appropriate education will substitute for the required experience on a year-for-year basis. Relevant education will be calculated as the following:

• An associates will count as two years of experience
• A bachelors will count as four years of experience
• A masters degree will count for six years of experience
• A doctorate or juris doctorate degree will count for seven years of experience

Note: Per the Job Application Fairness Act, you may redact information that identifies your age, date of birth, or dates of attendance at or graduation from an educational institution on your transcripts.

Preferred Qualifications

• Previous relevant professional state experience
• Advanced degree from an accredited institution in social sciences or a closely related field.
• Behavioral Therapy Credential, behavioral health professional licensure, or other relevant nationally recognized credential (BCaBA equivalent or higher).
• Professional experience:
• Administering, developing, implementing or overseeing a health care benefit or program, including responsibility for benefit policy, coverage requirements, or program operations.
• Analyzing, interpreting, applying, monitoring or maintaining federal and state Medicaid statutes, regulations, State Plan requirements, or other Medicaid authorities to policy or compliance decisions.
• Analyzing health care utilization, expenditure, access, quality, compliance, or performance data and using findings to develop or recommend policy, operational, or quality‑improvement changes.
• Providing authoritative technical guidance or consultation on complex health care policy or program matters to senior leadership, providers, contractors, government partners, advocates, or other stakeholders.

Skills To Support Success

• Ability to interpret ambiguous, conflicting, or novel federal and state requirements and translate them into defensible policy and operational decisions.
• Ability to analyze multifaceted clinical, regulatory, operational, reimbursement, and access issues and develop practical, sustainable solutions.
• Ability to evaluate utilization, expenditure, access, quality, compliance, and outcome data and use findings to make policy or program recommendations.
• Ability to lead complex, cross‑functional initiatives from policy development through implementation while managing competing priorities, dependencies, risks, and deadlines.
• Ability to communicate complex clinical, regulatory, and policy concepts clearly and persuasively to technical and non‑technical audiences.
• Ability to navigate competing perspectives and stakeholder interests while maintaining regulatory compliance, program integrity, fiscal stewardship, and member access as priorities.
• Ability to rapidly research unfamiliar issues, evaluate new information and evidence, and adjust recommendations as policy, regulation, data, or program conditions change.
• Ability to make timely, well‑reasoned decisions in situations involving substantial programmatic, fiscal, compliance, operational, or member‑access consequences.

Definition of Professional Experience:

Work that involves exercising discretion, analytical skill, judgment, personal accountability, and responsibility for creating, developing, integrating, applying, and sharing an organized body of knowledge that characteristically is uniquely acquired through an intense education or training regimen at a recognized college or university; equivalent to the curriculum requirements for a bachelor's or higher degree with major study in or pertinent to the specialized field; and continuously studied to explore, extend, and use additional discoveries, interpretations, and application and to improve data, materials, equipment, applications and methods.

Conditions of Employment

• All positions at HCPF are security sensitive positions and require that the individuals undergo a criminal record background check as a condition of employment.
• Employees who have been disciplinary terminated, resigned in lieu of disciplinary termination, or negotiated their termination from the State of Colorado must disclose this information on the application.

Appeal Rights

An applicant who has been removed from an employment list or removed from consideration during the selection process may request a review by the State Personnel Director.

As an applicant directly affected by the results of the selection or comparative analysis process, you may file a written appeal with the State Personnel Director.

Review of the completed, signed, and submitted appeal will be timely on the basis of written material submitted by you, using the official appeal form signed by you or your representative. This form must be completed and delivered to the State Personnel Board by email at [e-mail] within ten (10) calendar days from your receipt of notice or acknowledgment of the Department’s action.

For further information on the Board Rules, you can refer to 4 Colorado Code of Regulations (CCR) 801-1, State Personnel Board Rules and Personnel Director's Administrative Procedures, Chapter 8, Resolution of Appeals and Disputes, at spb.colorado.gov/board-rules.