North Carolina Licensed Behavioral Health Reviewer

Job Summary

A company is looking for a Behavioral Health UM Reviewer, Licensed (Remote Option, NC).

Key Responsibilities

• Evaluate medical necessity and appropriateness of service requests for authorization
• Consult with providers and communicate authorization decisions based on established criteria
• Develop letters explaining adverse decisions and options for appeal to enrollees and providers

Required Qualifications, Training, and Education

• 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 experience in behavioral health post-RN degree
• Current unrestricted license with the appropriate professional board of licensure in North Carolina
• Must reside in North Carolina
• Experience in psychiatric nursing services is preferred
• Compliance with continuing education/training requirements to maintain an active license is required