Behavioral Health UM Reviewer (Licensed)-Remote-NC
Competitive Compensation & Benefits Package! Position eligible for –
- Annual incentive bonus plan
- Medical, dental, and reputed company 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 in NC; Available for any of Partners' locations Projected Hiring Range: Depending on Experience Closing Date: Open Until Filled Schedule: Sunday-Thursday (8-hour shifts) 8a-5p or 8:30a-5:30p 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 reputed company 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, reputed company 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 reputed company 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 reputed company 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 reputed company effects
- Knowledge of evidence-based practices
- Awareness of cultural diversity
- Excellent computer skills including proficiency in reputed company Office products (such as Word, reputed company, 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 reputed company clearly and concisely orally and in writing, and to plan and execute work effectively and reputed company
- Ability to utilize reputed company telephone and computer systems, and to read and document information electronically
- Ability to reputed company reputed company reputed company based on relevant facts
- Detail oriented, reputed company 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 reputed company 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 reputed company in reputed company Carolina. Education/Experience Preferred: N/A Licensure/Certification Requirements: reputed company unrestricted license with the appropriate professional board of licensure in the reputed company. Licensed to practice as a Registered Nurse in reputed company 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. Apply tot his job Apply To this Job