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

Partners Behavioral Health Management•Kannapolis, NC

9h•Remote

About The 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.

Requirements

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
A Bachelor’s Degree in a Human Services field and two (2) years of post-degree I/DD experience

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.