IDD UM Care Reviewer (Remote NC)

Location

Remote – must live in North Carolina or within 40 miles of the NC border. The person in this role is required to maintain residency in North Carolina or within 40 miles of the NC border.

General statement of job

The IDD UM Care Reviewer 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 UM Care Reviewer screens authorization requests for completeness, approves or administratively denies some requests based on review check-sheets, and refers requests that cannot be approved to IDD UM Clinicians, Care Coordinators or other appropriate individuals when service provision is inconsistent with the approved plan.

Essential job functions

Review of Service Plans and Authorization Requests

• Ensure all required documents are submitted with Service Plans and Authorization Requests for specific benefit plans
• Review of plan and service requests for completeness
• Collection and transfer of non-clinical data
• Gather clinical information but does not engage in the evaluation or interpretation of clinical information
• Consult with licensed clinical staff when performing initial screening activities
• Approve requests and plans based on review check-sheets
• Refer plan and authorization requests that cannot be approved to I/DD UM Clinicians
• Administratively deny incomplete requests

Monitor the Delivery of Monitored Services

• Identify provider/ Care Coordinator training needs; provide training as needed and requested
• Identify and document service gaps and deficiencies in access to services
• Contact providers to gather information about the delivery of services between authorization reviews
• Where providers report service provision inconsistent with the plan, forward in formation to a I/DD UM Clinicians or Care Coordinator.

Additional Reviews

• Participation in Post Payment Review or other quality assurance reviews as requested.

Other Duties as Assigned.

• Knowledge, skills, & abilities
• Knowledge of the assessment and treatment of developmental disabilities, with or without co-occurring mental illness, is a necessity.
• Ability to learn and understand legal, waiver and program practices/requirements and apply this knowledge in problem-solving and responding to questions/inquiries.
• 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.
• Detail oriented, able to independently organize multiple tasks and priorities, and to effectively manage an assigned caseload under pressure of deadlines.
• Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) and Vaya information system.

Education & experience requirements

Bachelor’s degree in Special Education, Psychology, Social Work or closely related Human Services area and two (2) years of post-degree professional experience. Must qualify as a Qualified Professional for Developmental Disabilities.

• Physical requirements
• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
• Mental concentration is required in all aspects of work.

Residency requirements

The person in this position is required to reside in North Carolina or within 40 miles of the NC border.

SALARY

Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation.

Deadline for application: Open Until Filled

APPLY

Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/ [https://www.vayahealth.com/about/careers/].

Vaya Health is an equal opportunity employer.