Remote UM Clinical Specialist – Behavioral Health

Alliance Health Plan; Morrisville (NC); Hybrid; USD 70,000 - 89,000; Full time

Benefits offered by this job

Generous retirement savings plan

Hybrid/remote options

Paid time off including vacation and S

Job summary

Alliance Health Plan in North Carolina is seeking a UM Clinical Specialist-Behavioral Health (Full Time, Remote, North Carolina Based). The role emphasizes utilization reviews, care management, and ensuring services under Medicaid B waiver, with a remote schedule and occasional Alliance Office visits in Morrisville.

The candidate should hold a Master’s in a Human Services field or Nursing with 5+ years of relevant experience, be licensed in NC, and demonstrate strong case management and

Qualifications

• 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).
• OR: Master’s degree in Psychiatric Nursing with five (5) years of psychiatric nursing experience.
• OR: Bachelor of Science in Nursing with five (5) years of psychiatric nursing experience.
• Must hold current active license by NC Board (LCSW, LCAS, LP, LPA, LMFT, LCMHC, or RN).
• Experience in public behavioral healthcare or UM environment is valuable.

Responsibilities

• Independently conducts medical necessity reviews of service requests against clinical guidelines within mandated turn-around times.
• Conduct utilization reviews to monitor adherence to guidelines and ensure services delivered as requested.
• Engage in care management activities including follow-up calls and case staffing with psychologists and medical staff.
• Monitor consumer plans to ensure effective interventions and adjust as needed.
• Provide linkage and authorizations for level of care determinations; support providers with problem solving.
• Notify members of adverse determinations and maintain due process rights.

Skills

Case management

Written communication

Oral communication

Problem solving

Microsoft Office

Education

Master’s in Human Services field

Master’s in Nursing (Psychiatric/PMH)

Bachelor of Science in Nursing

Tools

Microsoft Office

Job description

Alliance Health Plan in North Carolina is seeking a UM Clinical Specialist-Behavioral Health (Full Time, Remote, North Carolina Based). The role emphasizes utilization reviews, care management, and ensuring services under Medicaid B waiver, with a remote schedule and occasional Alliance Office visits in Morrisville.

The candidate should hold a Master’s in a Human Services field or Nursing with 5+ years of relevant experience, be licensed in NC, and demonstrate strong case management and