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Job description
Empower, a Provider-Led Arkansas Shared Savings Entity (PASSE) serving Medicaid clients with complex behavioral health and developmental disabilities, is seeking compassionate and detail-driven Behavioral Health Clinicians to support the utilization management process for behavioral health (BH). This role requires collaboration with hospital staff, providers, and internal teams to ensure timely, clinically appropriate care while aligning with regulatory and organizational standards.
Key Responsibilities:
Evaluate member's treatment for mental health before, during, and after services to ensure the level of care and services are appropriate.
Performs prior authorization reviews related to mental health such as: Admission and concurrent reviews for inpatient cases
Admission and concurrent reviews for psychiatric residential treatment facilities (PRTFs)
Reviews for outpatient Home and Community Based Services
Communicate effectively with providers to gather additional clinical information and ensure smooth coordination of care.
Identify potential quality-of-care concerns and escalate appropriately to the Quality Improvement team.
Determine medical necessity using various criteria, such as InterQual, to ensure members receive the most appropriate level of care.
Review clinical documentation for consistency with established criteria and escalate cases to Behavioral Health Medical Directors when they do not meet medical necessity guidelines.
Maintain thorough and timely documentation in relevant systems to maintain all service level agreements (SLAs)
Compiles and presents cases in staffing and integrated rounds.
Collaborate with peers and leadership to support the continuous improvement of behavioral health utilization management operations.
Required: Active, unrestricted license in social work, counseling, psychology, or a related field (e.g., LCSW, LPC, LMFT, Psy.D ) or nursing with behavioral health experience.
Utilization management experience for at least one year is required.
Strong knowledge of behavioral health clinical guidelines and utilization management practices.
Familiarity with behavioral health resources and Medicaid services in Arkansas.
Excellent communication and critical thinking skills.
Ability to work independently while contributing to a collaborative team environment.
Experience in managed care or behavioral health utilization review.
Worksite address
little rock, AR, 72208, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.