NC Licensed Behavioral Health Nurse

Job Summary

To support a collaborative healthcare team, the full-time Remote Behavioral Health Utilization Review Nurse will evaluate behavioral health and substance abuse cases for medical necessity and authorization eligibility while working from home.

Key responsibilities

• Review inpatient, outpatient, and other healthcare service requests for medical necessity using clinical guidelines and policies
• Make authorization determinations and communicate outcomes to members and providers
• Manage a caseload of behavioral health and substance abuse reviews, coordinating peer-to-peer reviews as needed

Required qualifications

• Active RN license with at least 3 years of clinical experience or active LPN license with at least 5 years of clinical experience
• Current and valid NC or Compact Multistate Nursing License
• Experience in utilization management, medical necessity reviews, and authorization determinations
• Familiarity with behavioral health, substance abuse, or eating disorder cases
• Strong computer skills and ability to navigate multiple systems simultaneously