Top 31 Utilization management reviewer Jobs in Cornelius, Nc

Behavioral Health UM Reviewer (Licensed)-Adult Team-Remote-NC
Partners Health Management —Kannapolis, NC
- $60,653.49 - $75,816.87 a year
- 8 hour shift
- Remote
- LMFT
- Nursing
- Microsoft Excel
- Paid holidays
- Disability insurance
Utilization Review RN Appeals Specialist
CaroMont Health —Gastonia, NC
- Full-time
- Nursing
- RN License
- Hospital
Employee Benefit Analyst IV
USI Holdings Corporation —Charlotte, NC
- Remote
- Computer literacy
- Mid-level
- High school diploma or GED
- Wellness program
- Health savings account
Prior Authorization Systems Pharmacist
Judi Health —Charlotte, NC
- $128,000 - $150,000 a year
- Full-time
- Microsoft Word
- System design
- 3 years
- Wellness program
- Health savings account
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Department Manager | CMT Services - Charlotte
BUNNELL LAMMONS ENGINEERING —Cornelius, NC
- Full-time
- 8 years
- Travel
- Senior level
- Paid holidays
- Disability insurance
Quick Apply
Department Manager | Environmental Due Diligence and Remediation Services - Charlotte
BUNNELL LAMMONS ENGINEERING —Cornelius, NC
- Full-time
- 8 years
- Travel
- Senior level
- Paid holidays
- Disability insurance
Quick Apply
Department Manager | Geotechnical Services - Charlotte
BUNNELL LAMMONS ENGINEERING —Huntersville, NC
- Full-time
- 8 years
- Analysis skills
- Travel
- Paid holidays
- Disability insurance
Quick Apply
Practice Area Leader - Structural Practice Group
Terracon —Charlotte, NC
- Engineering
- Office
- 8 years
- Paid holidays
- Health insurance
Staff Associate | Geostructures
BUNNELL LAMMONS ENGINEERING —Charlotte, NC
- Full-time
- Travel
- US work authorization
- 2 years
- Paid holidays
- Disability insurance
Quick Apply

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Utilization Specialist
Rebound Behavioral Health —Lancaster, SC
Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or…
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Utilization Review RN Appeals Specialist
CaroMont Health —Gastonia, NC
Current state-issued RN license. Utilize pre-existing criteria and other resources and clinical evidence to develop sound and well-supported appeal arguments,…

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

Partners Health Management -
Kannapolis, NC

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Job Details

Full-time
$60,653.49 - $75,816.87 a year

Benefits

Paid holidays
Disability insurance
Health insurance
Dental insurance
Pension plan
Vision insurance
401(k) matching
Loan forgiveness

Qualifications

Collaborate with healthcare professionals
LMFT
Nursing
Completing CE credits
Microsoft Excel
Microsoft Outlook
LCMHC
RN License
Caseload management
Writing skills
Licensed Clinical Social Worker
Public mental health
Mid-level
Master's degree
Evidence-based practice
Pre-authorization review for utilization management
Utilization management
Medical treatment knowledge
Decision making
Master's degree in human services
Resource utilization in healthcare
Document review
Concurrent review in utilization management
Human Services
LCAS
Psychopharmacology
2 years

Full Job Description

Competitive Compensation & Benefits Package!

Position eligible for –

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

See attachment for additional details.

Office Location: Remote option in NC; Available for any of Partners' locations

Projected Hiring Range: Depending on Experience
Closing Date: Open Until Filled

Schedule: Tuesday-Saturday (8-hour shifts); or Monday-Friday (8-hours shifts)

Primary 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 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

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 provision
Considerable knowledge of person-centered and recovery philosophies and interventions
Considerable 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
Awareness of cultural diversity
Excellent 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 stakeholders
Ability to express ideas clearly and concisely orally and in writing, and to plan and execute work effectively and efficiently
Ability to utilize complex telephone and computer systems, and to read and document information electronically
Ability to make prompt decisions based on relevant facts
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 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.

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Refine Your Search

utilization management reviewer jobs in cornelius, nc

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

Utilization Review RN Appeals Specialist

Employee Benefit Analyst IV

Prior Authorization Systems Pharmacist

Department Manager | CMT Services - Charlotte

Department Manager | Environmental Due Diligence and Remediation Services - Charlotte

Department Manager | Geotechnical Services - Charlotte

Practice Area Leader - Structural Practice Group

Staff Associate | Geostructures

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