Utilization Management Specialist III – MH/SU
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Job Description
Utilization Management Specialist reviewing behavioral health and substance-use service requests for North Carolina members. Making clinical authorization decisions, triaging care, and advising providers.
Responsibilities:
- Provide comprehensive clinical review of service requests for people experiencing psychiatric symptoms related to mental health issues, substance use, developmental disabilities, or co-occurring conditions
- Review diagnoses, medical necessity criteria, member eligibility, and level of care needs
- Make service authorization decisions with timely, clear, concise documentation
- Provide clinical triage for members seeking services through Screening, Triage and Referral
- Provide consultation and technical assistance to providers regarding clinical care needs, levels of care, Client Rights Rules, evidence-based practices, and scope-of-practice issues
- Conduct ongoing review, staffing, and consultation of treatment documentation for members participating in group, family, or individual services
Requirements:
- Master's degree in health and human services or related field
- One (1) year of experience providing Utilization Management services
- Active North Carolina licensure as: Licensed Clinical Social Worker (LCSW), Licensed Clinical Mental Health Counselor (LCMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Psychological Associate (LPA), Licensed Clinical Addictions Specialist (LCAS), or Registered Nurse (RN)
- Must have a valid driver's license
- Must reside within North Carolina
- Must be able to travel within catchment as required
- Preferred: A minimum of two (2) years of post-Master's experience in a clinical setting with the BH/MH/SU/IDD population
- All candidates must pass a drug test as a condition of employment
- Resume must include employer name, dates of service, average hours worked per week, essential job duties, education details, and licensure/certification information if applicable
Benefits:
- A collaborative, mission-driven work environment
- Competitive benefits
- Work-from-home options for most positions
- Opportunities for professional growth in a diverse inclusive culture
- Flexible work schedules with some roles with management approval
- Health Insurance with no premium for employee coverage
- Flexible Spending Accounts
- 24 days of Paid Time Off (PTO) plus 12 paid holidays in your first year
- NC Local Government Retirement Pension (defined-benefit plan)
- 401k with 5% employer match and immediate vesting
- Public Service Loan Forgiveness (PSLF) qualifying employer
- Quarterly stipend for remote work supplies
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