Appeals & Grievances (A&G) Clinician

Empower, a Provider-Led Arkansas Shared Savings Entity (PASSE) serving Medicaid clients with complex behavioral health, developmental, or intellectual disabilities is seeking a detail-oriented and analytical A&G Clinician to conduct clinical reviews of appeals and grievances.

Key Responsibilities:

• Conduct clinical reviews for:
  • Prospective, inpatient, and retrospective denied services
  • Medical necessity determinations
  • Benefit denials and rescission of coverage decisions
• Summarize clinical findings and present information for internal and external reviews (including Medical Directors and Independent Review Organizations).
• Ensure all appeals and grievances are handled within required regulatory timeframes.
• Accurately document and track appeal/grievance cases in appropriate systems.
• Draft professional written correspondence to providers, members, and regulatory entities as needed.
• Communication with providers and members related to the appeals process.

• Required:
  • Active and current Behavioral Health license (e.g., LPC, LPE, LCSW, Psy.D) including nursing (e.g. RN) with behavioral health experience
• Strong clinical judgment and attention to detail.
• Excellent verbal and written communication skills.
• Familiarity with regulatory standards related to healthcare appeals and grievances preferred