Competitive Compensation & Benefits Package!
Position eligible for –
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Annual incentive bonus plan
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Medical, dental, and vision insurance with low deductible/low cost health plan
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Generous vacation and sick time accrual
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12 paid holidays
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State Retirement (pension plan)
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401(k) Plan with employer match
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Company paid life and disability insurance
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Wellness Programs
See attachment for additional details.
Location: Hybrid option; Available for any Partners' 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:
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Review of Service Plans and Authorization Requests to:
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Ensure that all required documents are submitted with Service Plans and Authorization Requests for specific benefit plans
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Approve requests based on an algorithm for “auto approval” of the plan and authorization requests
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Refer plan and authorization requests that cannot be “auto approved” to Licensed Utilization Management Reviewer for medical necessity review
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Administratively deny incomplete requests
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Onboarding/training/mentoring of new staff as requested by leadership.
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Other duties as needed to support the Supervisor, Manager, and Director.
Knowledge, Skills and Abilities:
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Comprehensive knowledge of mental illness and diagnostic categories
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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
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Knowledge of the 1915 (b) (c) waiver
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Knowledge of psychiatric medications and side effects
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Knowledge of evidence based practices
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Knowledge of appropriate treatments for major diagnostic categories
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Exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts and established processes
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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)
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Ability to make prompt decisions based on relevant facts
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Detail oriented, able to independently organize multiple tasks and priorities, and to effectively manage an assigned caseload under pressure of deadlines
Education/Experience Required: A Bachelor’s Degree in a Human Services field and two (2) years of post-degree I/DD experience.
Licensure/Certification Requirements: None