CES Waiver Utilization Reviewer – Elevate Care

Empower Healthcare Solutions, LLC.; Arkansas; On-site; USD 55,000 - 70,000; Full time

Job summary

Empower Healthcare Solutions, LLC. in Arkansas seeks a detail-driven Utilization Reviewer for CES Waiver Services to support utilization management for Medicaid members. You will collaborate with providers and internal teams to ensure timely, clinically appropriate care.

The role focuses on medical necessity reviews, accurate documentation, and alignment with regulatory standards, with opportunities to contribute to program improvements and care coordination.

Qualifications

• Experience with CES Waiver or similar Medicaid programs.
• Understanding of managed care and Arkansas Medicaid services.
• Excellent written and verbal communication skills.

Responsibilities

• Perform prior authorization reviews for CES Waiver services.
• Communicate with providers to gather clinical information for authorization.
• Determine medical necessity using established criteria.
• Review documentation for consistency with criteria and escalate when needed.
• Identify quality concerns and escalate to Quality Improvement teams.
• Maintain thorough documentation in relevant systems and SLAs.
• Compile and present cases in staffing and integrated rounds.
• Support continuous improvement of utilization management operations.

Skills

Communication

Critical thinking

Independent work

Team collaboration

Education

High School Diploma

Job description

Empower Healthcare Solutions, LLC. in Arkansas seeks a detail-driven Utilization Reviewer for CES Waiver Services to support utilization management for Medicaid members. You will collaborate with providers and internal teams to ensure timely, clinically appropriate care.

The role focuses on medical necessity reviews, accurate documentation, and alignment with regulatory standards, with opportunities to contribute to program improvements and care coordination.