North Carolina Licensed Behavioral Health Reviewer

A company is looking for a Behavioral Health UM Reviewer (Licensed) for the Adult Team in a remote setting in North Carolina. Key Responsibilities Evaluate medical necessity and appropriateness of services requested for authorization Respond to authorization requests from providers and consult with them regarding decisions Develop communication letters for enrollees and providers regarding adverse decisions and appeal options Required Qualifications, Training, and Education Master's Degree in a Human Services field with clinical licensure or a Registered Nurse with two years of behavioral health experience Current unrestricted license in North Carolina as a Registered Nurse or independent clinical license (LCSW, LCMHC, LPA, LMFT) Two years of post-Master's experience in behavioral health or equivalent RN experience Must reside in North Carolina Compliance with continuing education/training requirements to maintain an active license