Behavioral Health UM Reviewer – Adult Team

🕒 4 days ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

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Partners Health Management

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2012

⚕️ Healthcare Insurance

Healthcare Insurance • Health Care • Mental Health

Partners Health Management is a local management entity and managed care organization that focuses on providing essential mental health services, supports for individuals with intellectual and developmental disabilities, and substance use disorder services. Their mission is to assist members and their families in accessing the necessary care and resources to improve their overall well-being and integration into the community.

📋 Description

• This position will evaluate medical necessity, appropriateness and efficiency of the services requested for authorization against established criteria adopted by the LME/MCO. • To respond to all 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, concurrent 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 when 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.

🎯 Requirements

• A Master’s Degree in a Human 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. • Current unrestricted license with the appropriate professional board of licensure in the state of North Carolina. • Licensed to practice as a Registered Nurse in North 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.

🏖️ Benefits

• Competitive Compensation & Benefits Package! • 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