Remote Behavioral Health Clinical Specialist

Alliance Health in; Morrisville (NC); Remote; USD 70.000 - 89.000; Vollzeit

Benefits dieser Stelle

Generous retirement savings plan

Hybrid/remote options

Paid time off including vacation, sick

Dress flexibility

Zusammenfassung

Alliance Health in Morrisville, NC is seeking a UM Clinical Specialist-Behavioral Health to perform medical necessity reviews and active care management for Medicaid B waiver services. The role will focus on utilization management, provider coordination, and ensuring services meet clinical guidelines.

The position emphasizes remote work with occasional Alliance Office visits for meetings, requiring strong regulatory knowledge, MCO processes, and licensure in NC.

Qualifikationen

• Master’s degree in a Human Services field (such as Psychology, Social Work or Counseling) and at least five (5) years of post-degree clinical experience providing similar services to the population served (MH/SUD).
• Master's degree in Psychiatric Nursing or five (5) years of experience in psychiatric nursing.
• Bachelor of Science in Nursing with five (5) years of experience in psychiatric nursing.
• Current and active license issued by a North Carolina Professional Board (e.g., LCSW, LCAS, LP, LPA, LMFT, LCMHC, RN)

Aufgaben

• Independently conducts medical necessity reviews of service requests against clinical guidelines.
• Monitors adherence to clinical practice guidelines and determines if services were delivered as requested.
• Engages in care management activities including follow-up calls and case staffing with psychologists and medical staff.
• Monitors person-centered plans and provides consultation for adjustments to meet needs.
• Reports on over/under utilization by consumers and providers.
• Provide linkage, authorizations and level of care determinations; support problem solving with providers and Care Coordinators.

Kenntnisse

Case management principles

Written and oral communication

Interpersonal and presentation skills

DSM-5-TR diagnostic criteria

Time management

Problem solving

Coordinate with agencies

Regulatory interpretation

Microsoft Office

Ausbildung

Bachelor of Science in Nursing

Master’s degree in Psychology

Master’s degree in Counseling

Master’s degree in Human Services

Master’s degree in Social Work

Tools

Microsoft Office

Jobbeschreibung

Alliance Health in Morrisville, NC is seeking a UM Clinical Specialist-Behavioral Health to perform medical necessity reviews and active care management for Medicaid B waiver services. The role will focus on utilization management, provider coordination, and ensuring services meet clinical guidelines.

The position emphasizes remote work with occasional Alliance Office visits for meetings, requiring strong regulatory knowledge, MCO processes, and licensure in NC.