Utilization Management Specialist II

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

📋 Description

• Assist in clinical evaluations by confirming service authorization requests and overseeing the workflow from intake to determination.

• Assess service authorization requests in accordance with benefit criteria and submission standards prior to clinical assessment or during post-payment evaluations.

• Detect any missing or inconsistent documentation and acquire necessary information from providers.

• Direct complete requests to the relevant clinical reviewers based on the type of service and urgency.

• Monitor authorization deadlines and follow up to avert delays in clinical assessments.

• Record determinations and ensure that authorization status is accurately represented in the systems.

⛳️ Requirements

• High School Diploma/GED with six (6) years of experience in the MH/SU/IDD field; OR an Associate’s degree with four (4) years of experience in the MH/SU/IDD field; OR a Bachelor’s degree with two (2) years of experience in the MH/SU/IDD field; OR an equivalent combination of education and experience.

• A valid driver’s license is required.

• Candidates must reside within North Carolina.

• Ability to travel within the designated catchment area as needed.

• Preferred: Experience working with the PH/BH/MH/SU/IDD population.

• Preferred: Knowledge of and familiarity with medical terminology.

• All applicants must successfully complete a drug test as a condition of employment.

🏝️ Benefits

• Collaborative, mission-focused work environment.

• Attractive benefits package.

• Work-from-home options available for most positions.

• Flexible work schedules for certain roles with managerial approval.

• Health insurance with no premium for employee coverage.

• Flexible Spending Accounts.

• 24 days of Paid Time Off (PTO) plus 12 paid holidays in the first year.

• NC Local Government Retirement Pension (defined-benefit plan).

• 401k with a 5% employer match and immediate vesting.

• Employer qualifies for Public Service Loan Forgiveness (PSLF).

• Quarterly stipend for remote work supplies.