Remote Behavioral Health Utilization Specialist

Alliance Health; Morrisville (NC); Hybride; USD 70 000 - 89 000; Plein temps

Avantages offerts par ce poste

Medical insurance

Dental insurance

Vision insurance

Life insurance

Long-term disability

Retirement savings plan

Hybrid/Remote work options

Paid time off

Dress flexibility

Résumé du poste

Alliance Health in Morrisville, NC is seeking an UM Clinical Specialist-Behavioral Health to perform utilization reviews and care management for PHIP-enrolled providers. The role emphasizes reviewing medical necessity for Medicaid B waiver services with flexibility for a primarily remote schedule and occasional office attendance for meetings.

Requirements include a Master’s in a Human Services field or Nursing with 5 years of related experience and an active NC license (e.g., LCSW, LCAS, RN).

Qualifications

• Master’s degree with 5+ years of post‑degree clinical experience in MH/SUD.
• Alternate: Master’s in Psychiatric Nursing with 5 years in psychiatric nursing.
• OR: BSN with 5 years in psychiatric nursing experience.
• Must hold an active NC professional license (e.g., LCSW, LCAS, LP, LPA, LMFT, LCMHC, RN).

Responsabilités

• Independently conduct medical necessity reviews for service requests per guidelines.
• Perform utilization reviews to ensure adherence to clinical standards.
• Engage in care management with referrals and case staffing with clinicians.
• Monitor person-centered plans and adjust as needed to meet consumer needs.
• Document decisions in the authorization system and coordinate with teams.

Connaissances

Case management

Communication

DSM-5-TR knowledge

Time management

Problem solving

Inter-agency collaboration

Formation

Masters in Human Services

Bachelors in Nursing

Masters in Psychology

Masters in Social Work

Masters in Counseling

Outils

Microsoft Office

Description du poste

Alliance Health in Morrisville, NC is seeking an UM Clinical Specialist-Behavioral Health to perform utilization reviews and care management for PHIP-enrolled providers. The role emphasizes reviewing medical necessity for Medicaid B waiver services with flexibility for a primarily remote schedule and occasional office attendance for meetings.

Requirements include a Master’s in a Human Services field or Nursing with 5 years of related experience and an active NC license (e.g., LCSW, LCAS, RN).