Manage utilization review for behavioral health: perform concurrent and retrospective chart reviews, process prior authorizations, consult multidisciplinary teams, represent with payers on appeals, provide training, supervise clinicians, support quality and accreditation, and ensure compliance with regulatory and payer requirements.
ARKANSAS CHILDREN'S IS A TOBACCO FREE WORKPLACE. FLU VACCINES ARE REQUIRED. ARKANSAS CHILDREN'S IS AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION, GENDER IDENTITY OR EXPRESSION, NATIONAL ORIGIN, AGE, DISABILITY, PROTECTED VETERAN STATUS OR ANY OTHER CHARACTERISTIC PROTECTED BY FEDERAL, STATE, OR LOCAL LAWS.
This position has been designated as safety sensitive and cannot be filled by a candidate who is a current user of medical marijuana.CURRENT EMPLOYEES: Please apply via the internal career site by logging into your Workday Account (https://www.myworkday.com/archildrens/)and search the "Find Jobs" report.
Work Shift:
Day ShiftTime Type:
Full timeDepartment:
CC017217 Children's Specialty ServicesSummary:Arkansas Children's Behavioral Health, FT, M-F, 8a-5pAdditional Information:The Utilization Manager improves overall quality of clinical documentation to ensure that information in the medical record accurately reflects client's care and progress, and thus utilization of resources. This role works with providers to correctly capture that services being delivered are medically necessary and timely.
RN or LPC Required
Masters Degree Required
3 years in Mental Health/ Hospital Setting
Required Education:Master's degree in a related field of study.Recommended Education:Master's degree in a related field of study., Master's Degree NursingRequired Work Experience:Recommended Work Experience:Required Certifications:1 of the following certifications is required - Recommended Certifications:Licensed Certified Social Worker (LCSW) - Arkansas Professional Board, Licensed Professional Counselor (LPC) - Arkansas Board of Examiners in Counseling, RN License (AR or Compact State) - Arkansas State Board of Nursing (ASBN)Description1. Complete concurrent and retrospective medical record reviews to ensure services are appropriate, efficient, and compliant with payer and regulatory guidelines.
2. Process pre-authorizations and requests for services that are medically necessary and adherent to payer rules.
3. Consult with multidisciplinary team members regarding patient diagnosis, medical justification, length of treatment, and case documentation.
4. Represents the clinical and administrative team with payers for any appeals or disagreements related to care plans.
5. Provide training and education about utilization requirements to clinical and supervisory staff.
6. Demonstrate competency on mental health symptomology, treatment options and efficacies, and impact of trauma and mental health on overall well-being.
7. Participate in quality or accreditation audits to ensure program compliance on utilization review regulations.
8. Completes clinical supervision and staffing to clinicians completing their required supervision hours for full licensure, if necessary.
9. Knowledge of regulatory requirements and Arkansas laws governing services to children, adolescent and adults preferred.
10. Other duties as assigned.
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