North Carolina Licensed Behavioral Health Reviewer

Job Summary

To evaluate the medical necessity and appropriateness of behavioral health services, the full-time North Carolina Licensed Behavioral Health Reviewer will manage authorization requests, consult with providers, and develop communication letters for adverse decisions in a remote setting.

Key responsibilities

• Respond to authorization requests from providers, guided by medical necessity and clinical guidelines
• Review and authorize initial, concurrent, urgent, and retrospective requests
• Consult with providers and develop letters communicating reasons 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 of licensure in North Carolina (LCSW, LCMHC, LPA, LMFT, or RN)
• Comprehensive knowledge of mental illness, treatment principles, and recovery philosophies
• Ability to engage in collegial discussions regarding plans of care and clinical practices
• Excellent computer skills, including proficiency in Microsoft Office products