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

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

Remote Option Available; Flexible for any of Partners' NC locations.

Projected Hiring Range: Depending on Experience

Closing Date: Open Until Filled

Primary Purpose of 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.

Role and 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.