Arkansas Licensed Service Determination Specialist

Job Summary

Responsible for processing medical necessity and service health care reviews, the full-time Arkansas Licensed Service Determination Specialist will work remotely to assist with discharge planning and care coordination for members, ensuring the appropriateness of authorizations for home and community-based supports.

Key responsibilities:

• Conducts reviews of service requests and collaborates with providers to address concerns from clinical quality audits
• Leads care coordination efforts for members receiving intensive treatment and manages prior authorization for various services
• Maintains knowledge of regulations and ensures compliance with state and federal standards while presenting clinical cases to Medical Directors

Required qualifications:

• Nursing degree from an accredited RN program or Bachelor's degree in a healthcare field, or equivalent relevant experience
• Current unrestricted clinical license as a Registered Nurse, Social Worker, Psychologist, or Clinical Counselor in Arkansas
• Preferred experience in utilization review or case management related to BH/SUD/IDD/HCBS/Waiver services
• Familiarity with Medicaid, Medicare, and Managed Care systems is preferred
• Valid licensure or certification in Substance Use is preferred