What are the responsibilities and job description for the Behavioral Health UM Reviewer-QP (Remote/Hybrid) position at Partners Health Management?
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
See attachment for additional details.
Office Location: Hybrid/Remote option; Available for any of Partners' locations
Closing Date: Open Until Filled
Schedule: Mon-Fri, 8 AM - 5 PM
Primary Purpose of Position:
This position is responsible for processing non-clinical authorization requests and other administrative duties related to processing of SARs. The QP 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 reviewers for medical necessity review.
Responsibilities include, but are not limited to, the following:
- Process non-clinical approvals (pass-through authorizations)
- Complete administrative reviews of SARs, send out request for Information notices, and process admin denials during periods of heavy volume
- Research high priority cases and develop UM timelines
- Complete manual letters as necessary
- Back up team lead in managing Peer Review spreadsheets
- Test system enhancements in the staging system
- Complete system enhancement requests and report requests in collaboration with IT
- Run reports as needed for UM Supervisors, UM Manager and UM Director
- Prepare files for audits, i.e. , NCQA, URAC, and EQR
- Special projects as assigned by supervisor
Knowledge, Skills and Abilities:
- Comprehensive knowledge of mental illness and diagnostic categories.
- Knowledge of the assessment and treatment of mental illness is a necessity.
- Knowledge of the Medicaid Direct, Tailored Plan and 1915i services option
- 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 2 years of post-degree BH experience or Bachelor’s Degree and 4 years post-degree BH experience.
Licensure/Certification Requirements: NA
