Behavioral Health Utilization Management Clinician, LCSW, LPC, LMFT, RN, LSATP

This is a fully remote position, open to applicants in North Carolina, +1 more state.

📋 Description

• Evaluate clinical information obtained from providers to ensure that clinical data sufficiently meets Medical Necessity Criteria and authorize services when necessary.

• Implement medical necessity criteria for behavioral health and substance use services, DMAS protocols, clinical protocols, and clinical review standards.

• Enforce contractual, regulatory, and compliance standards for government, self-funded, and commercial payers.

• Ensure that accurate and appropriate information is entered into the claims system for payment processing.

• Assist in behavioral health utilization management for substance abuse services.

⛳️ Requirements

• A Master’s degree in Counseling, Social Work, or Marriage and Family Therapy is required; for Registered Nurses, a Bachelor of Science in Nursing is required.

• Must possess a valid license in the state of practice.

• One qualifying credential is necessary: LCSW, LPC, LMFT, RN single-state or multistate nursing license, LSATP, CSAC, or LCDC.

• At least 2 years of behavioral health experience is required.

• A minimum of 1 year of case management experience is required.

• Experience with substance abuse across American Society of Addiction Medicine (ASAM) levels of care is preferred.

• Preferred experience in utilization management.

• Familiarity with behavioral health and substance use medical necessity criteria.

• Understanding of DMAS protocols, clinical protocols, and clinical review standards.

• Knowledge of contractual, regulatory, and compliance standards for government, self-funded, and commercial payers.

• Ability to work flexible dayshift hours, starting between 6am and 9am EST, Monday through Friday.

🏝️ Benefits

• Medical, Dental, Vision plans.

• Adoption, Fertility, and Surrogacy Reimbursement up to $10,000.

• Paid Time Off and Sick Leave.

• Paid Parental & Family Caregiver Leave.

• Emergency Backup Care.

• Long-Term, Short-Term Disability, and Critical Illness plans.

• Life Insurance.

• 401k/403B with Employer Match.

• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education.

• Student Debt Pay Down – $10,000.

• Reimbursement for certifications and free access to complete CEUs and professional development.

• Pet Insurance.

• Legal Resources Plan.

• Opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria are met.

• Flexible dayshift work hours.