UM Behavioral Health Clinical Specialist — Remote

Alliance; Charlotte (NC); Hybrid; USD 70,000 - 89,000; Full time

Benefits offered by this job

Retirement plan

Hybrid/Remote options

Paid time off

Dress flexibility

Job summary

Alliance seeks a UM Clinical Specialist-Behavioral Health to perform utilization reviews and management for Medicaid B waiver services. The role is primarily remote with occasional Alliance Office visits in Morrisville, NC.

The candidate will ensure medical necessity reviews, care coordination, and adherence to clinical guidelines. Requires a Master’s degree in a related field, 5+ years of post-degree experience in MH/SUD, and active NC licenses.

Qualifications

• Master’s degree in a Human Services field and at least five years of post-degree clinical experience providing MH/SUD services.
• License from a North Carolina Professional Board (LCSW, LCAS, LP, LPA, LMFT, LCMHC, or RN).
• Experience with medical necessity reviews and utilization management under Medicaid B waiver and state-funded benefits.
• Knowledge of DSM-5-TR diagnostic criteria and relevant regulations.
• Strong written and oral communication skills; ability to coordinate across agencies.

Responsibilities

• Independently conducts medical necessity reviews of service requests against clinical guidelines within mandated timelines.
• Engage in care management activities and provider follow-up; coordinate with psychologists and medical staff.
• Monitor care plans and ensure appropriate referrals and adjustments to meet consumer needs.
• Notify members of adverse determinations and maintain records in authorization systems.

Skills

Case management

Communication

Microsoft Office

Education

Bachelor of Science in Nursing

Master’s degree in Counseling

Master’s degree in Human Services

Master’s degree in Psychology

Master’s degree in Social Work

Job description

Alliance seeks a UM Clinical Specialist-Behavioral Health to perform utilization reviews and management for Medicaid B waiver services. The role is primarily remote with occasional Alliance Office visits in Morrisville, NC.

The candidate will ensure medical necessity reviews, care coordination, and adherence to clinical guidelines. Requires a Master’s degree in a related field, 5+ years of post-degree experience in MH/SUD, and active NC licenses.