Remote Behavioral Health Utilization Review Nurse

Remote Utilization Management Clinical ReviewerIf you're a clinically driven RN or LPN with utilization management experience and a passion for making meaningful coverage decisions, this remote opportunity offers the chance to directly impact member care and outcomes. Join a collaborative team where your expertise in medical necessity review and behavioral health services helps ensure members receive the appropriate level of care.Location: RemotePay Rate: $40-$45/hourEmployment Type: ContingentSchedule: Monday-Friday, 8:00 AM-5:00 PMWhy This Role MattersIn this role, you will evaluate behavioral health and substance abuse cases to determine medical necessity and authorization eligibility. Your clinical judgment will play a critical role in ensuring members receive the appropriate care while maintaining compliance with established guidelines, policies, and regulatory requirements.What You'll Do• Review assigned inpatient, outpatient, and other healthcare service requests for medical necessity using clinical guidelines, policies, and benefit criteria• Make authorization determinations and provide notifications to members and providers as required• Communicate with providers to obtain additional clinical information needed to complete reviews• Coordinate peer-to-peer reviews and facilitate secondary reviews with Medical Directors when appropriate• Document review outcomes accurately and thoroughly within internal systems• Analyze and summarize clinical information to support utilization management decisions• Collaborate with internal clinical and non-clinical teams to ensure timely case resolution• Manage a caseload of behavioral health and substance abuse reviews across multiple levels of careWhat We're Looking For• A current, up-to-date resume• Active RN license with at least 3 years of clinical experience, or active LPN license with at least 5 years of clinical experience• Current and valid NC or Compact Multistate Nursing License• Experience with utilization management, medical necessity reviews, and authorization determinations• Experience reviewing behavioral health, substance abuse, or eating disorder cases• Insurance industry experience and understanding of payer guidelines and processes• Strong computer skills with the ability to navigate multiple systems simultaneously• Working knowledge of Microsoft Outlook and other standard business applications• Excellent communication skills and ability to interact professionally with providers and clinical teams• Ability to meet compliance requirementsWhat's In It For You• Fully remote opportunity with a nationally recognized healthcare organization• Competitive hourly pay• Opportunity to utilize and expand your utilization management expertise• Collaborative environment with ongoing interaction among providers and healthcare professionals• Meaningful work impacting patient care and healthcare access decisionsBenefits for Manpower Associates (Upon Eligibility)Upon completion of waiting period associates are eligible for:• Medical and Prescription Drug Plans• Dental Plan• Supplemental Life Insurance• Short Term Disability Insurance• 401(k)