What are the responsibilities and job description for the I/DD Utilization Management Reviewer, QP (Remote-NC) position at Partners Behavioral 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
- Public Service Loan Forgiveness Qualifying Employer
See attachment for additional details.
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