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 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