<p>Are you passionate about making a meaningful impact on the lives of individuals facing mental health challenges, while working behind the scenes? If so, <b>Utilization Management</b> might be the perfect fit for you! In this role, you’ll play a critical part in shaping care decisions and improving outcomes, all without direct, face-to-face interaction.</p><h3>What You’ll Do</h3><ul><li>Apply your knowledge of <b>Behavioral Health</b> and <b>Withdrawal Management diagnoses</b>.</li><li>Navigate the <b>continuum of care</b> and levels of care for Behavioral Health and Withdrawal Management.</li><li>Present cases confidently and effectively during clinical rounds.</li><li>Work independently with minimal supervision.</li><li>Excel in a <b>fast-paced, dynamic environment</b>.</li></ul><p><b>Our Ideal Candidates will have an RN or Social Work license and:</b></p><ul><li><b>3 years</b> - Clinical behavioral health / substance use disorder experience required</li><li><b>1 year</b> - Must be knowledgeable about community care resources and levels of behavioral health care available.</li></ul><p><b>Along with</b>:</p><ul><li><b>3+ years</b> of experience in <b>Psychiatric and/or Substance Use</b> treatment.</li><li>Background in <b>Behavioral Health settings</b> (both inpatient and outpatient).</li><li>Prior experience in <b>Utilization Management</b> or <b>Managed Care</b>.</li><li>Strong <b>communication and presentation skills</b>.</li><li>Ability to work autonomously and manage time effectively.</li><li>Adaptability and resilience in a rapidly changing work environment.</li></ul><p><b>Why Choose Us?</b><br>This is more than a job; it’s an opportunity to make a lasting difference in people’s lives while leveraging your expertise in a collaborative, supportive setting.</p><h3>Job Responsibilities</h3><ul><li>Assists non-clinical staff in performance of administrative reviews</li><li>Initiate referrals to ensure appropriate coordination of care.</li><li>Seek the advice of the Medical Director when appropriate, according to policy.</li><li>Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility.</li><li>Various immunizations and/or associated medical tests may be required for this position.</li></ul><h3>Job Qualifications</h3><p><i>License</i></p><ul><li>Current, active unrestricted Tennessee license in Nursing (RN) or behavioral health field (Master's level or above) (Ph.D., LCSW/LMSW, LLP, MHC, LPC, etc.) required. RN may hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law.</li></ul><p><i>Experience</i></p><ul><li>3 years - Clinical behavioral health / substance use disorder experience required</li></ul><p><i>Skills\Certifications</i></p><ul><li>Must be knowledgeable about commun