Utilization Management Clinician – Tuesday, Saturday

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Collaborate extensively with physicians, nurses, social workers, and a diverse array of medical and non-medical professionals to ensure coordinated healthcare service delivery.

• Evaluate the member’s specific health plan benefits along with additional medical, community, or financial resources that are accessible.

• Deliver utilization management (UM) services that foster quality, cost-effective outcomes by assisting member populations in achieving effective use of healthcare services.

• Promote exceptional member care through financially responsible strategies.

• Gather and evaluate member information relevant to the member’s history, condition, and functional capabilities to encourage wellness, appropriate utilization, and cost-effective care and services.

• Coordinate essential resources to meet member outcome goals and objectives.

⛳️ Requirements

• A minimum of three (3) years of nursing or behavioral health experience with a diverse background in medical and/or behavioral health is required.

• Preferred experience in acute care, case management, including cases necessitating rehabilitation, home health, behavioral health, and hospice treatment.

• An active, unrestricted Registered Nurse (RN) license, Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Licensed Clinical Social Worker (LCSW), or Psychiatric Mental Health Nurse Practitioner (PMHNP) credential is required.

• Case Manager Certification accredited by CCMC is preferred.

• Comprehensive knowledge and understanding of medical and behavioral health processes, diagnoses, care modalities, procedure codes including ICD and CPT Codes, health insurance, and state-mandated benefits.

• Proficiency in utilizing computerized systems for data recording and retrieval.

🏝️ Benefits

• Health insurance

• 401(k)

• Paid time off

• Flexible work arrangements