Behavioral Health UM Reviewer (Licensed)-Adult Team (Remote-NC)

Competitive Compensation & Benefits Package! Position eligible for – Annual incentive bonus planMedical, dental, and vision insurance with low deductible/low cost health planGenerous vacation and sick time accrual12 paid holidaysState Retirement (pension plan)401(k) Plan with employer matchCompany paid life and disability insuranceWellness ProgramsSee attachment for additional details. Office Location: Remote option in NC; Available for any of Partners' locationsProjected Hiring Range: Depending on ExperienceClosing Date: Open Until FilledPrimary Purpose of Position:This position will evaluate medical necessity, appropriateness and efficiency of the services requested for authorization against established criteria adopted by the LME/MCO. Role and Responsibilities: To respond to all requests for authorizations from the provider community with appropriate authorization decision that is guided by medical necessity and clinical guidelinesServices are authorized based on individual need and standardized proceduresReview and authorize initial requests, concurrent requests, urgent requests and retrospective requestsConsulting with providers regarding authorization requestsConsultation 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 treatmentDevelopment 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 Knowledge, Skills and Abilities: Comprehensive knowledge of mental illness and appropriate treatment for major diagnostic categories; behavioral health principles, techniques, and practices, and their application to complex treatment and service provisionConsiderable knowledge of person-centered and recovery philosophies and interventionsConsiderable knowledge of assessments and interventions for mental health, developmental disability and substance use disorders;Knowledge of the 1915 (b) (c) waiverKnowledge of psychiatric medications and side effectsKnowledge of evidence-based practicesAwareness of cultural diversityExcellent computer skills including proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.)Ability to engage providers in collegial discussions about plans of care and best clinical practices for consumer Ability to establish and maintain effective working relationships with consumers and their families as well as civic, legal, medical, social, and religious stakeholdersAbility to express ideas clearly and concisely orally and in writing, and to plan and execute work effectively and efficientlyAbility to utilize complex telephone and computer systems, and to read and document information electronicallyAbility to make prompt decisions based on relevant factsDetail oriented, able to independently organize multiple tasks and priorities, and to effectively manage an assigned caseload under pressure of deadlines Education/Experience Required: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.Must reside in North Carolina. Education/Experience Preferred: N/A Licensure/Certification Requirements: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.