Behavioral Health Utilization Specialist

Empower Healthcare Solutions, LLC.; Little Rock (AR); Sur place; USD 55 000 - 75 000; Plein temps

Résumé du poste

Empower Healthcare Solutions LLC is seeking experienced Behavioral Health Clinicians to support utilization management for Medicaid-related behavioral health services in Little Rock, AR. The role requires collaboration with hospital staff, providers, and internal teams to ensure timely, clinically appropriate care while meeting regulatory standards.

The position focuses on evaluating treatment levels, conducting prior authorization reviews for inpatient, PRTF, and outpatient BH services, and

Qualifications

• Active, unrestricted license in social work, counseling, psychology, or nursing with behavioral health experience.
• Utilization management experience for at least one year.
• 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.

Responsabilités

• Evaluate member’s treatment for mental health to ensure appropriate level of care.
• Perform prior authorization reviews for inpatient, PRTFs, and outpatient BH services.
• Communicate with providers to gather clinical information and coordinate care.
• Identify quality-of-care concerns and escalate to the Quality Improvement team.
• Determine medical necessity using criteria like InterQual.
• Review clinical documentation for consistency with criteria and elevate cases as needed.
• Maintain documentation in systems to meet SLAs.
• Compile and present cases in staffing and rounds.
• Collaborate with peers and leadership to improve operations.

Connaissances

Communication

Critical thinking

Independent work

Team collaboration

Formation

LCSW; LPC; LMFT; Psy.D licensure

Nursing license with behavioral health experience

Description du poste

Empower Healthcare Solutions LLC is seeking experienced Behavioral Health Clinicians to support utilization management for Medicaid-related behavioral health services in Little Rock, AR. The role requires collaboration with hospital staff, providers, and internal teams to ensure timely, clinically appropriate care while meeting regulatory standards.

The position focuses on evaluating treatment levels, conducting prior authorization reviews for inpatient, PRTF, and outpatient BH services, and