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

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; 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. NC residency required.

Licensure/Certification Requirements: NA