Key Facts

Remote From:

Full time

Mid-level (2-5 years)

English

Hard Skills

Utilization Management Behavioral Health Case Management Systems Substance Abuse Assessments Electronic Health Record Applications Peer Review Evidence-Based Practice Health Risk Assessments Mental Health Assessments Person-Centered Therapy Clinical Informatics Telephony Clinical Documentation Developmental Assessment Psychiatric Medications Cultural Studies

Other Skills

•
Microsoft Office
•
Ability To Meet Deadlines
•
Time Management
•
Critical Thinking
•
Detail Oriented
•
Prioritization
•
Verbal Communication Skills
•
Social Skills

Roles & Responsibilities

Master’s Degree in a Human Services field with clinical licensure and two years of post-master’s experience in behavioral health, or a Registered Nurse with two years of post-degree behavioral health experience
Current unrestricted license in North Carolina (RN or independent license such as LCSW, LCMHC, LPA, LMFT)
Must reside in North Carolina
Responsible for meeting licensure board continuing education/training requirements to maintain an active license

Requirements:

Respond to all authorization requests from the provider community with appropriate authorization decisions guided by medical necessity and clinical guidelines
Review and authorize initial, concurrent, urgent, and retrospective requests following standardized procedures
Consult with providers regarding authorization requests and consult with Partners BHM physician on complex cases involving authorization, enrollee health and safety issues, medication issues, or need for Peer Review
Develop letters communicating to enrollees and providers the reason for adverse decisions and information about appeal options

Partners Health Management

About Partners Health Management

You will often hear people call Partners a North Carolina local management entity/managed care organization or LME/MCO. We think of ourselves as an MCO…a Member Care Organization™. Partners manages Medicaid, state and local funds for mental health, intellectual/developmental disability, substance use disorder and traumatic brain injury services. The system of care we manage is shaped by the choices of our members and their families and designed to meet the unique needs of each of the communities we serve. Partners manages care in Burke, Cabarrus, Catawba, Cleveland, Davie, Forsyth, Gaston, Iredell, Lincoln, Rutherford, Surry, Stanly, Union and Yadkin Counties. Our Crisis Line is available all day, every day at 1-888-235-HOPE (4673). Learn more about us at www.PartnersBHM.org.

Company type: SME

Founded: 2018

Company size: 201 - 500

Website LinkedIn See all jobs →

Job description

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

See attachment for additional details.

Office Location: Remote option in NC; Available for any of Partners' locations

Projected Hiring Range: Depending on Experience
Closing Date: Open Until Filled

Primary Purpose of Position:

This position will evaluate medical necessity, appropriateness and efficiency of the services requested for authorization against established criteria adopted by the LME/MCO.

Role and Responsibilities:

To respond to all requests for authorizations from the provider community with appropriate authorization decision that is guided by medical necessity and clinical guidelines
Services are authorized based on individual need and standardized procedures
Review and authorize initial requests, concurrent requests, urgent requests and retrospective requests
Consulting with providers regarding authorization requests
Consultation with Partners BHM physician regarding requests in which there is a question regarding authorization, enrollee health and safety issues, medication issues, lack of response to services and need for Peer Review when the MHSU Utilization Management Reviewer cannot approve the request for treatment
Development of letters that communicate to enrollees and providers the reason for any adverse decision and offers information regarding the options to appeal any adverse decision

Knowledge, Skills and Abilities:

Comprehensive knowledge of mental illness and appropriate treatment for major diagnostic categories; behavioral health principles, techniques, and practices, and their application to complex treatment and service provision
Considerable knowledge of person-centered and recovery philosophies and interventions
Considerable knowledge of assessments and interventions for mental health, developmental disability and substance use disorders;
Knowledge of the 1915 (b) (c) waiver
Knowledge of psychiatric medications and side effects
Knowledge of evidence-based practices
Awareness of cultural diversity
Excellent computer skills including proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.)
Ability to engage providers in collegial discussions about plans of care and best clinical practices for consumer
Ability to establish and maintain effective working relationships with consumers and their families as well as civic, legal, medical, social, and religious stakeholders
Ability to express ideas clearly and concisely orally and in writing, and to plan and execute work effectively and efficiently
Ability to utilize complex telephone and computer systems, and to read and document information electronically
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 Master’s Degree in a Human Services field with clinical licensure and two (2) years of post-Master’s experience in behavioral health or a Registered Nurse with two (2) years of experience in behavioral health, post RN degree.

Must reside in North Carolina.

Education/Experience Preferred: N/A

Licensure/Certification Requirements:

Current unrestricted license with the appropriate professional board of licensure in the state of North Carolina. Licensed to practice as a Registered Nurse in North Carolina by the N. C. Board of Nursing or Independent License in NC as a LCSW, LCMHC, LPA, LMFT. An Associate license does not meet the requirements. An employee may be dual licensed with one of the specialties listed here can also be licensed as an LCAS. NC DMA contract requirements does not allow for an LCAS to be a standalone license for working in UM. Employee is responsible for complying with respective licensure board’s continuing education/training requirements to maintain an active license.