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

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

📋 Description

• Evaluate clinical information provided by healthcare providers to confirm that clinical data meets Medical Necessity Criteria and authorize services as required.

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

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

• Accurately input relevant information into the claims system to facilitate payment processing.

• Assist in care coordination, discharge planning, continuity of care, and transitions of care.

⛳️ Requirements

• A Master's degree in Counseling, Social Work, or Marriage and Family Therapy is mandatory.

• For Registered Nurses, a Bachelor of Science in Nursing is required.

• A valid state-of-practice license is essential.

• Must possess one qualifying credential: LCSW, LPC, LMFT, RN single-state or multistate nursing license, LSATP, CSAC, or LCDC.

• A minimum of 2 years of experience in behavioral health is required.

• At least 1 year of experience in case management is necessary.

• Previous experience in Inpatient Behavioral Health and health plans is preferred.

• Familiarity with medical necessity criteria for behavioral health and substance use services is essential.

• Understanding of DMAS protocols, clinical protocols, and clinical review requirements is required.

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

• Must be able to work flexible daytime hours, starting between 6 AM and 9 AM EST, Monday through Friday.

• This position is available to candidates located in Virginia or North Carolina.

🏝️ Benefits

• Medical, Dental, and Vision insurance options.

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

• Paid Time Off and Sick Leave.

• Paid Parental & Family Caregiver Leave.

• Emergency Backup Care services.

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

• Life Insurance coverage.

• 401k/403B plan with Employer Match.

• Tuition Assistance of $5,250 per year and discounted educational opportunities via Guild Education.

• Student Debt Pay Down program offering $10,000.

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

• Pet Insurance options.

• Legal Resources Plan available.

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

• Family-friendly workplace culture.

• Commitment to professional development and ongoing employment opportunities.