I/DD Utilization Management Reviewer (QP)-Remote NC

IDD Utilization Management Reviewer

Competitive Compensation & Benefits Package!

Position eligible for:

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer

Office Location: Remote Option Available; Flexible for any of Partners' NC locations.

Projected Hiring Range: Depending on Experience

Closing Date: Open Until Filled

Primary Purpose of Position: This position is responsible for facilitating the review of service plans and service authorization requests to ensure that individuals are receiving the most appropriate services at a given time. The IDD Utilization Management Reviewer screens authorization requests for completeness, approves some requests based on an algorithm for "auto-approval" of the authorization requests, and refers requests that cannot be "auto-approved" to Licensed Utilization Management Reviewers for medical necessity review.

Role and Responsibilities:

• Review of Service Plans and Authorization Requests to:
• Ensure that all required documents are submitted with Service Plans and Authorization Requests for specific benefit plans
• Approve requests based on an algorithm for "auto approval" of the plan and authorization requests
• Refer plan and authorization requests that cannot be "auto approved" to Licensed Utilization Management Reviewer for medical necessity review
• Administratively deny incomplete requests
• Onboarding/training/mentoring of new staff as requested by leadership.
• Other duties as needed to support the Supervisor, Manager, and Director.

Knowledge, Skills and Abilities:

• Comprehensive knowledge of mental illness and diagnostic categories
• Knowledge of the assessment and treatment of developmental disabilities, with or without co-occurring mental illness, is a necessity. Additionally, the incumbent should be able to learn and understand legal, waiver and program practices/requirements and apply this knowledge in problem-solving and responding to questions/inquiries
• Knowledge of the 1915 (b) (c) waiver
• Knowledge of psychiatric medications and side effects
• Knowledge of evidence based practices
• Knowledge of appropriate treatments for major diagnostic categories
• Exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts and established processes
• Problem solving, negotiation and conflict resolution skills are essential to balance the needs of both internal and external customers
• Awareness of cultural diversity
• Excellent computer skills including proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc)
• Ability to make prompt decisions based on relevant facts
• Detail oriented, able to independently organize multiple tasks and priorities, and to effectively manage an assigned caseload under pressure of deadlines

Education/Experience Required: A Bachelor's Degree in a Human Services field and two (2) years of post-degree I/DD experience

Licensure/Certification Requirements: NA