Utilization Management Specialist III – MH/SU

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

📋 Description

• Conduct thorough clinical assessments of service requests for individuals experiencing psychiatric symptoms associated with mental health issues, substance use, developmental disabilities, or co-occurring conditions.

• Evaluate diagnoses, medical necessity criteria, member eligibility, and required levels of care.

• Make timely service authorization decisions supported by clear and concise documentation.

• Offer clinical triage for members requesting services through Screening, Triage, and Referral.

• Provide consultation and technical support to providers regarding clinical care requirements, levels of care, Client Rights Rules, evidence-based practices, and scope-of-practice matters.

• Perform ongoing reviews, staffing, and consultations of treatment documentation for members engaged in group, family, or individual services.

⛳️ Requirements

• A Master's degree in health and human services or a related field.

• At least one (1) year of experience in providing Utilization Management services.

• Active licensure in North Carolina as one of the following: Licensed Clinical Social Worker (LCSW), Licensed Clinical Mental Health Counselor (LCMHC), Licensed Marriage and Family Therapist (LMFT), Licensed Psychological Associate (LPA), Licensed Clinical Addictions Specialist (LCAS), or Registered Nurse (RN).

• A valid driver's license is required.

• Candidates must reside in North Carolina.

• Ability to travel within the catchment area as necessary.

• Preferred: A minimum of two (2) years of post-Master's experience in a clinical setting with the BH/MH/SU/IDD population.

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

• Resumes should detail employer names, dates of service, average hours worked per week, key job responsibilities, education information, and licensure/certification details if applicable.

🏝️ Benefits

• A collaborative, mission-driven work environment.

• Competitive benefits package.

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

• Opportunities for professional development within a diverse and inclusive culture.

• Flexible work schedules available for some roles with management approval.

• Health Insurance with no premium for employee coverage.

• Flexible Spending Accounts.

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

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

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

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

• Quarterly stipend for remote work supplies.