Utilization Management Specialist II

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Utilization Management Specialist II based in the United States.

This role supports the coordination and administrative accuracy of utilization management and service authorization processes.
You will validate authorization requests and ensure submissions meet applicable benefit and documentation requirements.
The position plays an important role in keeping clinical review workflows accurate, organized, and timely.
You will collaborate with providers and clinical reviewers to resolve missing or inconsistent information.
The role offers an opportunity to contribute to services supporting individuals with behavioral health and intellectual/developmental needs.
You will work in a collaborative, mission-driven environment with opportunities for professional growth.
The position is remote within North Carolina, with flexibility and travel requirements as applicable.

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Accountabilities:

• Review and validate service authorization requests against benefit requirements and submission standards, including post-payment reviews when applicable.

• Check requests for completeness, accuracy, and required supporting documentation before they proceed to clinical review.

• Identify missing, inconsistent, or incomplete information and coordinate with providers to obtain the necessary documentation.

• Route complete requests to the appropriate clinical reviewer based on service type, urgency, and established workflows.

• Monitor authorization timelines and follow up proactively to help prevent delays in clinical review and decision-making.

• Track authorization determinations and maintain accurate status information within relevant systems.

• Support efficient utilization management workflows while maintaining accuracy, confidentiality, and adherence to established procedures.

Requirements:

• High school diploma/GED plus 6 years of experience working in the mental health, substance use, or intellectual/developmental disabilities (MH/SU/IDD) field; or

• Associate degree plus 4 years of relevant experience; or

• Bachelor’s degree plus 2 years of relevant experience; or

• An equivalent combination of education and relevant professional experience.

• Experience working with behavioral health, mental health, substance use, physical health, or intellectual/developmental disability populations is preferred.

• Familiarity with medical terminology and healthcare-related documentation is preferred.

• Strong attention to detail and the ability to identify missing or inconsistent information.

• Excellent organizational and time-management skills, with the ability to manage multiple requests and deadlines.

• Effective written and verbal communication skills, particularly when working with providers and clinical teams.

• Ability to work independently while collaborating effectively within a multidisciplinary environment.

• A valid driver’s license is required.

• Candidates must reside within North Carolina and be able to travel within the assigned service area when required.

Benefits:

• Salary range of $56,270–$69,898 annually.

• Remote work options for most positions, with this role specifically based remotely within North Carolina.

• Typical working hours of 8:30 a.m.–5:00 p.m., with flexible schedules available for some roles subject to management approval.

• Health insurance with no employee premium for employee coverage.

• Flexible Spending Accounts (FSAs).

• 24 days of paid time off (PTO) plus 12 paid holidays during the first year.

• North Carolina Local Government Retirement System defined-benefit pension.

• 401(k) plan with a 5% employer match and immediate vesting.

• Eligibility for Public Service Loan Forgiveness (PSLF).

• Quarterly stipend to support remote-work supplies.

• Collaborative, mission-driven workplace focused on supporting individuals and families.

• Opportunities for professional development and growth within an inclusive work environment.

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How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

 Why Apply Through Jobgether? 

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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