UM Clinical Specialist-LTSS ( Full Time, Remote, North Carolina Based)

This position performs professional and administrative work, primarily utilization review and utilization management to ensure economical and effective consumer service delivery by the PHIP enrolled network providers. The position is responsible for providing reviews of individualized service plans and requests for authorization of services to ensure consumers receive services in the least restrictive, most integrated setting appropriate to their individual needs.

The position’s primary role is to review services for members identified as meeting ICF Level of Care and participating in the Innovations Waiver 1915 (c), Traumatic Brain Injury Waiver.