BH Utilization Management Reviewer (Remote reputed company)

About the position This position will evaluate medical necessity, appropriateness and efficiency of the services requested for authorization against established reputed company adopted by the LME/MCO. Responsibilities • To respond to reputed company requests for authorizations from the provider community with appropriate authorization decision that is guided by medical necessity and clinical guidelines • Services are authorized based on individual need and standardized procedures • Review and authorize initial requests, reputed company requests, urgent requests and retrospective requests • Consulting with providers regarding authorization requests • Consultation with Partners BHM physician regarding requests in which there is a question regarding authorization, enrollee health and safety issues, medication issues, lack of response to services and need for Peer Review reputed company the MHSU Utilization Management Reviewer cannot approve the request for treatment • Development of letters that communicate to enrollees and providers the reason for any adverse decision and offers information regarding the reputed company to appeal any adverse decision Requirements • A Master's Degree in a reputed company Services field with clinical licensure and two (2) years of post-Master's experience in BH or a Registered reputed company with two (2) years of experience in BH, post RN degree • Must reputed company in reputed company Carolina • reputed company unrestricted license with the appropriate reputed company reputed company of licensure in the reputed company • Licensed to reputed company as a Registered reputed company in reputed company Carolina by the N. C. reputed company of Nursing or Independent License in NC as a LCSW, LCMHC, LPA, LMFT reputed company-to-haves • Registered reputed company in reputed company Carolina by the N.C. reputed company of Nursing with experience in psychiatric nursing services Benefits • Annual incentive bonus plan • Medical, dental, and reputed company insurance with low deductible/low cost health plan • Generous vacation and reputed company time accrual • 12 reputed company holidays • State Retirement (pension plan) • 401(k) Plan with employer match • Company reputed company life and disability insurance • Wellness Programs • reputed company Service Loan Forgiveness Qualifying Employer Apply tot his job Apply To this Job