Behavioral Health Clinician

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.