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

Partners Behavioral Health Management•Morganton, NC

1d•Remote

About The Position

This position is responsible for supporting operations of the IDD section of the UM department and acts as a liaison between UM Reviewers and Peer Reviewers. Support and technical assistance is provided to UM Reviewers, Supervisor, Manager, and Director as well as other Partners departments and external providers in relation to utilization management.

Requirements

The Team Lead is a versatile position that requires flexibility, initiative, leadership skills, organization, and the ability to multi-task.
Comprehensive knowledge of I/DD as well as mental illness and other 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.
A Bachelor’s Degree in a Human Services field and two (2) years of post-degree IDD experience or Bachelor’s Degree and four (4) years post-degree IDD experience.

Responsibilities

Acts as liaison between UM Reviewer and Peer Reviewers.
Tracks Peer Reviews for turnaround time and quality assurance.
Summarizes monthly Peer Review data and provide analysis of UM Decisions.
Assists with developing and presenting UM specific trainings both internally and externally.
Provides technical assistance to Providers and Internal Staff regarding system concerns.
Completes productivity data (TAT and Volume) for the I/DD UM team.
Completes QA Data/Reporting for the I/DD Utilization Management Review Team.
Identifies systemic issues with Providers' submission of SARs.
Prepare and analyze Enhanced Rates reporting and Innovations Residential/Supervised Living (Burns data).
Prepares and analyzes Innovations Budget Variance Data.
Processes authorization requests for all levels of care to support fellow UM Reviewers as requested by UM leadership during periods of high volume and to ensure coverage.
Completes internal audits and identifies areas of needed training within the IDD UM Team.
Additional duties and projects as directed by UM leadership in coordination with Chief Medical Officer.
Maintain NC-SNAP data and all data entry for State NC-SNAP reporting.
Represent Partners UM on statewide Alpha Users call.
Provide support for some supervisor activities as needed for back-up. (Daily SAR reports, assignments, cases over 14 days).
Requests to move from Standard Plan to Medicaid Direct – process and manage spreadsheet. Complete troubleshooting as needed.
Provide staff training and development for on boarding new staff and seasoned staff.
Provide quality assurance for manual letters and letter statements.
Report issues to the Supervisor, Manager, and Director that require that level of attention.
Other duties as needed to support the Supervisor, Manager, and Director.