NC Licensed Behavioral Health Nurse

To support a collaborative healthcare team, the full-time Remote Behavioral Health Utilization Review Nurse will evaluate behavioral health and substance abuse cases for medical necessity and authorization eligibility while working from home. Key responsibilities Review inpatient, outpatient, and other healthcare service requests for medical necessity using clinical guidelines and policies Make authorization determinations and communicate outcomes to members and providers Manage a caseload of behavioral health and substance abuse reviews, coordinating peer-to-peer reviews as needed Required qualifications 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 in utilization management, medical necessity reviews, and authorization determinations Familiarity with behavioral health, substance abuse, or eating disorder cases Strong computer skills and ability to navigate multiple systems simultaneously