North Carolina Licensed Behavioral Health Reviewer

Job Summary

Evaluating medical necessity and appropriateness of services, the full-time North Carolina Licensed Behavioral Health Reviewer will manage authorization requests and consult with providers while working remotely in North Carolina.

Key responsibilities

• Respond to authorization requests from providers based on medical necessity and clinical guidelines
• Review and authorize initial, concurrent, urgent, and retrospective requests
• Consult with providers and develop communication letters for adverse decisions and appeal options

Required qualifications

• Master's Degree in a Human Services field with clinical licensure and two years of post-Master's experience in behavioral health, or a Registered Nurse with two years of behavioral health experience post-RN degree
• Current unrestricted license with the appropriate professional board in North Carolina (LCSW, LCMHC, LPA, LMFT, or RN)
• Comprehensive knowledge of mental illness treatment and behavioral health principles
• Ability to engage providers in discussions about clinical practices and plans of care
• Proficiency in Microsoft Office products and ability to manage an assigned caseload effectively