IDD UM Care Reviewer

Job not on LinkedIn

🕒 June 12

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $50k - $65k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

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Vaya Health

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1972

⚕️ Healthcare Insurance

🌍 Social Impact

Healthcare Insurance • Healthcare • Social Impact

Vaya Health is a North Carolina-based organization that manages services for individuals with behavioral health issues, including mental health and substance use disorders, intellectual and developmental disabilities (I/DD), and traumatic brain injuries (TBI). The organization provides Medicaid services tailored for these populations, focusing on a person-centered approach that connects members to the necessary care and support for their unique health and wellness goals. Vaya Health emphasizes collaboration across various care areas to ensure comprehensive support for its members, fostering healthier communities across the region.

📋 Description

• The IDD UM Care Reviewer 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. • Review of Service Plans and Authorization Requests: Ensure all required documents are submitted with Service Plans and Authorization Requests for specific benefit plans. • Review of plan and service requests for completeness. • Collection and transfer of non-clinical data. • Gather clinical information but does not engage in the evaluation or interpretation of clinical information. • Consult with licensed clinical staff when performing initial screening activities. • Approve requests and plans based on review check-sheets. • Refer plan and authorization requests that cannot be approved to I/DD UM Clinicians or Care Coordinators. • Administratively deny incomplete requests. • Monitor the Delivery of Monitored Services: Identify provider/ Care Coordinator training needs; provide training as needed and requested. • Identify and document service gaps and deficiencies in access to services. • Contact providers to gather information about the delivery of services between authorization reviews. • Where providers report service provision inconsistent with the plan, forward information to a I/DD UM Clinicians or Care Coordinator. • Participation in Post Payment Review or other quality assurance reviews as requested. • Other Duties as Assigned.

🎯 Requirements

• Bachelor’s degree in Special Education, Psychology, Social Work or closely related Human Services area • Two (2) years of post-degree professional experience • Must qualify as a Qualified Professional for Developmental Disabilities. • Knowledge of the assessment and treatment of developmental disabilities, with or without co-occurring mental illness • 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. • Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) and Vaya information system.