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
- Public Service Loan Forgiveness Qualifying Employer
See attachment for additional details.
Office Location: Flexible for any of our office locations: Remote Option
Projected Hiring Range: Depending on Experience
Closing Date: Open Until Filled
Primary Purpose of 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.
Role and 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.
Knowledge, Skills and Abilities:
- 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.
Education and Experience Required: 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.
Licensure/Certification Requirements: N/A