Job detail

Behavioral Health Clinician

EMPOWER HEALTHCARE SOLUTIONS

#Behavioral Health #Care Coordination #Mental Health #LMFT #Managed Care #Medicaid #LPC #LCSW #Clinical Guidelines #Prior Authorization #Medical Necessity #Utilization Management

Full Time On Site 2-5 yrsPosted 3 days ago

Location

Little Rock, Arkansas

Quick overview

Evaluate mental health treatment and perform prior authorization reviews to ensure appropriate levels of care for Medicaid clients. Collaborate with providers and internal teams to coordinate care and maintain clinical documentation standards.

Requirements summary

Requires an active, unrestricted license in social work, counseling, psychology, or nursing with behavioral health experience. Candidates must have knowledge of Arkansas Medicaid services and experience in managed care or utilization review.

bachelor degreepostgraduate degreeCase ManagementCommunication SkillsCare CoordinationClinical DocumentationCritical ThinkingMedical Necessity ReviewPrior AuthorizationUtilization ManagementInterQualBehavioral Health Assessment

Job description

Job DetailsLevel

ExperiencedJob
Location:
Empower
Healthcare
Solutions
LLC -
Little
Rock,
AR 72223Position
Type:
Full
TimeEducation
Level: 4
Year
DegreeSalary
Range: $1.00 - $1.00
SalaryTravel
Percentage:
NegligibleJob
Shift:
DayJob
Category: InsuranceEmpower, 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.
Qualifications
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. 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.