Behavioral Health UM Reviewer-Adult Team (Remote Option)
About the position
The Behavioral Health UM Reviewer for the Adult Team is responsible for evaluating the medical necessity, appropriateness, and efficiency of services requested for authorization. This role involves responding to authorization requests from providers, consulting with medical professionals, and developing communication regarding authorization decisions. The position is remote but available for any of the company's locations in North Carolina.
Responsibilities
Ā Respond to all requests for authorizations from the provider community with appropriate authorization decisions guided by medical necessity and clinical guidelines.
,
Ā Authorize services based on individual need and standardized procedures.
,
Ā Review and authorize initial requests, concurrent requests, urgent requests, and retrospective requests.
,
Ā Consult with providers regarding authorization requests.
,
Ā Consult with Partners BHM physician regarding requests with questions about authorization, enrollee health and safety issues, medication issues, and need for Peer Review.
,
Ā Develop letters communicating reasons for adverse decisions and options for appeal.
Requirements
Ā Master's Degree in a Human Services field with clinical licensure and two years of post-Master's experience in Behavioral Health, or a Registered Nurse with two years of experience in Behavioral Health post-RN degree.
,
Ā Current unrestricted license with the appropriate professional board of licensure in North Carolina.
Nice-to-haves
Ā Registered Nurse in North Carolina with experience in psychiatric nursing services.
Benefits
Ā Annual incentive bonus plan
,
Ā Medical, dental, and vision insurance with low deductible/low cost health plan
,
Ā Generous vacation and sick time accrual
,
Ā 12 paid holidays
,
Ā State Retirement (pension plan)
,
Ā 401(k) Plan with employer match
,
Ā Company paid life and disability insurance
,
Ā Wellness Programs
Apply Now
The Behavioral Health UM Reviewer for the Adult Team is responsible for evaluating the medical necessity, appropriateness, and efficiency of services requested for authorization. This role involves responding to authorization requests from providers, consulting with medical professionals, and developing communication regarding authorization decisions. The position is remote but available for any of the company's locations in North Carolina.
Responsibilities
Ā Respond to all requests for authorizations from the provider community with appropriate authorization decisions guided by medical necessity and clinical guidelines.
,
Ā Authorize services based on individual need and standardized procedures.
,
Ā Review and authorize initial requests, concurrent requests, urgent requests, and retrospective requests.
,
Ā Consult with providers regarding authorization requests.
,
Ā Consult with Partners BHM physician regarding requests with questions about authorization, enrollee health and safety issues, medication issues, and need for Peer Review.
,
Ā Develop letters communicating reasons for adverse decisions and options for appeal.
Requirements
Ā Master's Degree in a Human Services field with clinical licensure and two years of post-Master's experience in Behavioral Health, or a Registered Nurse with two years of experience in Behavioral Health post-RN degree.
,
Ā Current unrestricted license with the appropriate professional board of licensure in North Carolina.
Nice-to-haves
Ā Registered Nurse in North Carolina with experience in psychiatric nursing services.
Benefits
Ā Annual incentive bonus plan
,
Ā Medical, dental, and vision insurance with low deductible/low cost health plan
,
Ā Generous vacation and sick time accrual
,
Ā 12 paid holidays
,
Ā State Retirement (pension plan)
,
Ā 401(k) Plan with employer match
,
Ā Company paid life and disability insurance
,
Ā Wellness Programs
Apply Now