Behavioral Health Medical Director

Description

Empower, a Provider-Led Arkansas Shared Savings Entity (PASSE) serving Medicaid clients with complex behavioral health, developmental, or intellectual disabilities, is seeking an experienced and visionary Behavioral Health Medical Director to oversee and guide behavioral health and developmental disabilities programs. This role provides leadership in clinical policy, quality assurance, and integration of services into Empower’s overall care model. As a key clinical leader, you will support our members' behavioral health needs while ensuring alignment with regulatory requirements and clinical excellence.

Key Responsibilities

• Support leadership and direction for the Utilization Management program while managing the care for behavioral health and developmental disabilities.
• Provide clinical oversight on reviews for medical necessity cases as needed, to include:
  • 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
  • Reviews for Community and Employment Support Waiver Services to support members with developmental disabilities.
• Review and ensure consistent application of medical necessity criteria and guidelines.
• Consult with utilization management team to staff cases for the most appropriate level of care.
• Conduct consultations and peer reviews with providers regarding authorization requests.
• Serve as a clinical advisor and subject matter expert for policy development and committee engagement.
• Actively participate in continuous improvement activities including those that support quality of care and total cost of care oversight.

Qualifications

• Graduate of an accredited medical school.
• Psychiatrist with an active, unrestricted license in the State of Arkansas.
• Preferred license in Child and Adolescent Psychiatry
• 3–5 years of managed care experience
• Previous Medicaid experience