IDD UM Care Reviewer (Remote NC)

Vaya Health•Remote, Remote, NC, US, NC

20h•$50,007 - $65,009•Remote

About The Position

The IDD UM Care Reviewer 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 UM Care Reviewer screens authorization requests for completeness, approves or administratively denies some requests based on review check-sheets, and refers requests that cannot be approved to IDD UM Clinicians, Care Coordinators or other appropriate individuals when service provision is inconsistent with the approved plan.

Requirements

Knowledge of the assessment and treatment of developmental disabilities, with or without co-occurring mental illness, is a necessity.
Ability to learn and understand legal, waiver and program practices/requirements and apply this knowledge in problem-solving and responding to questions/inquiries.
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.
Detail oriented, able to independently organize multiple tasks and priorities, and to effectively manage an assigned caseload under pressure of deadlines.
Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) and Vaya information system.
Bachelor’s degree in Special Education, Psychology, Social Work or closely related Human Services area and two (2) years of post-degree professional experience.
Must qualify as a Qualified Professional for Developmental Disabilities.

Responsibilities

Ensure all required documents are submitted with Service Plans and Authorization Requests for specific benefit plans
Review of plan and service requests for completeness
Collection and transfer of non-clinical data
Gather clinical information but does not engage in the evaluation or interpretation of clinical information
Consult with licensed clinical staff when performing initial screening activities
Approve requests and plans based on review check-sheets
Refer plan and authorization requests that cannot be approved to I/DD UM Clinicians
Administratively deny incomplete requests
Identify provider/ Care Coordinator training needs; provide training as needed and requested
Identify and document service gaps and deficiencies in access to services
Contact providers to gather information about the delivery of services between authorization reviews
Where providers report service provision inconsistent with the plan, forward in formation to a I/DD UM Clinicians or Care Coordinator.
Participation in Post Payment Review or other quality assurance reviews as requested.
Other Duties as Assigned.