This bid is for utilization management and clinical services across Arkansas, with onsite support in Little Rock at 700 Main Street, Little Rock, Arkansas 72201.
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What the job is
Scope: Prior authorizations, continued-stay and extension-of-benefits reviews, retrospective audits, medical consultations, reconsiderations, and appeals support across medical, behavioral health, therapy, dental, and vision services.
Platform: Provide and maintain a HIPAA-compliant web portal with MMIS API integration, data exchanges, reporting, provider training, and support. All services and data must remain within the continental United States.
Clinical staffing: Appropriately credentialed Arkansas-licensed reviewers, a 0.75 FTE physician advisor in Little Rock, and embedded staff including 10 behavioral health clinicians, 1 FTE psychiatrist, and a geriatric APRN.
Review deadlines: Generally seven calendar days for standard requests and 72 hours for urgent requests, with shorter deadlines for specified services.
Qualifications: National utilization management accreditation, QIO eligibility, and capacity to obtain a performance bond covering 100% of the annual price.
Term and setup: Three years beginning February 1, 2027, or earlier, with up to four annual renewals. Implementation is required within 60 days and an Arkansas office within 90 days.
XL Eagle