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

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.Full Time Social Services Albemarle, NC, US 1 Attachments3 days ago Requisition ID: 2450Competitive Compensation & Benefits Package!Medical, dental, and vision insurance with low deductible/low cost health planGenerous vacation and sick time accrual12 paid holidaysState Retirement (pension plan)401(k) Plan with employer matchCompany paid life and disability insuranceWellness ProgramsPublic Service Loan Forgiveness Qualifying EmployerSee attachment for additional details.Office Location Remote Option Available; Flexible for any of Partners' NC locations.Projected Hiring Range Depending on ExperiencePrimary 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 ResponsibilitiesReview of Service Plans and Authorization Requests to:Ensure that all required documents are submitted with Service Plans and Authorization Requests for specific benefit plansApprove requests based on an algorithm for "auto approval" of the plan and authorization requestsRefer plan and authorization requests that cannot be "auto approved" to Licensed Utilization Management Reviewer for medical necessity reviewAdministratively deny incomplete requestsOnboarding/training/mentoring of new staff as requested by leadership.Other duties as needed to support the Supervisor, Manager, and Director.Knowledge, Skills and AbilitiesComprehensive knowledge of mental illness and diagnostic categoriesKnowledge 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/inquiriesKnowledge of the 1915 (b) (c) waiverKnowledge of psychiatric medications and side effectsKnowledge of evidence based practicesKnowledge of appropriate treatments for major diagnostic categoriesExceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts and established processesProblem solving, negotiation and conflict resolution skills are essential to balance the needs of both internal and external customersAwareness of cultural diversityExcellent computer skills including proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc)Ability to make prompt decisions based on relevant factsDetail oriented, able to independently organize multiple tasks and priorities, and to effectively manage an assigned caseload under pressure of deadlinesEducation/Experience Required A Bachelor's Degree in a Human Services field and two (2) years of post‐degree I/DD experienceLicensure/Certification Requirements NA#J-18808-Ljbffr