North Carolina Licensed Behavioral Health Reviewer

Job Summary

A company is looking for a Behavioral Health UM Reviewer (Licensed) for the Adult Team in a remote setting in North Carolina.

Key Responsibilities

• Evaluate medical necessity and appropriateness of services requested for authorization
• Respond to authorization requests from providers and consult with them regarding decisions
• Develop communication letters for enrollees and providers regarding adverse decisions and appeal options

Required Qualifications, Training, and Education

• Master's Degree in a Human Services field with clinical licensure or a Registered Nurse with two years of behavioral health experience
• Current unrestricted license in North Carolina as a Registered Nurse or independent clinical license (LCSW, LCMHC, LPA, LMFT)
• Two years of post-Master's experience in behavioral health or equivalent RN experience
• Must reside in North Carolina
• Compliance with continuing education/training requirements to maintain an active license