Behavioral Health Utilization Clinician

Empower Healthcare Solutions, LLC.; Northern (KY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Empower Healthcare Solutions, LLC in the United States seeks an experienced Behavioral Health Clinician to support the utilization management process for behavioral health services. This role collaborates with hospital staff, providers, and internal teams to ensure timely, clinically appropriate care while meeting regulatory and organizational standards.

Responsibilities include evaluating treatment levels, performing prior authorization reviews for inpatient and outpatient services,

Qualifications

• 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.
• One year minimum utilization management experience required.
• Strong knowledge of behavioral health clinical guidelines and utilization management practices.
• Familiarity with 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.

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 upscale 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 upscale 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.

Skills

Communication

Critical thinking

Independent worker

Education

4 Year Degree

Job description

Empower Healthcare Solutions, LLC in the United States seeks an experienced Behavioral Health Clinician to support the utilization management process for behavioral health services. This role collaborates with hospital staff, providers, and internal teams to ensure timely, clinically appropriate care while meeting regulatory and organizational standards.

Responsibilities include evaluating treatment levels, performing prior authorization reviews for inpatient and outpatient services,