Behavioral Health UM Reviewer – Adult Team

🕒 2 days ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $60.7k - $75.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

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Partners Health Management

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2012

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance • Health Care

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

• Evaluate medical necessity, appropriateness, and efficiency of requested services against established LME/MCO criteria • Respond to provider authorization requests with appropriate decisions guided by medical necessity and clinical guidelines • Authorize services based on individual needs and standardized procedures • Review initial, concurrent, urgent, and retrospective authorization requests • Consult with providers regarding authorization requests • Consult with the Partners BHM physician on authorization questions, enrollee health and safety issues, medication issues, lack of response to services, and need for Peer Review • Develop letters communicating adverse-decision reasons and appeal options to enrollees and providers

🎯 Requirements

• Master’s degree in a Human Services field with clinical licensure and two years of post-Master’s behavioral health experience; or Registered Nurse with two years of post-RN-degree behavioral health experience • Must reside in North Carolina • Current unrestricted license with the appropriate professional board of licensure in North Carolina • Registered Nurse license from the N.C. Board of Nursing, or independent North Carolina license as LCSW, LCMHC, LPA, or LMFT • Associate license does not meet the requirements • LCAS cannot be a standalone license for working in UM • Maintain an active license by complying with applicable licensure-board continuing education and training requirements • Comprehensive knowledge of mental illness, behavioral health principles, treatment, and service provision • Knowledge of person-centered and recovery philosophies and interventions • 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 side effects • Knowledge of evidence-based practices and cultural diversity • Proficiency in Microsoft Office products, including Word, Excel, and Outlook • Ability to use complex telephone and computer systems and document information electronically • Ability to make prompt decisions based on relevant facts • Ability to independently organize multiple tasks, priorities, and an assigned caseload under deadlines

🏖️ Benefits

• 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