Top 6 Utilization management reviewer Jobs in Greensboro, Nc

Behavioral Health UM Reviewer (Licensed)-Adult Team-Remote-NC
Partners Health Management —Winston-Salem, NC
- $60,653.49 - $75,816.87 a year
- 8 hour shift
- Remote
- LMFT
- Nursing
- Microsoft Excel
- Paid holidays
- Disability insurance
Behavioral Health UM Reviewer (Licensed)-Remote-NC
Partners Health Management —Winston-Salem, NC
- 8 hour shift
- Remote
- LMFT
- Nursing
- Microsoft Excel
- Paid holidays
- Disability insurance
Staff Associate | Geostructures
BUNNELL LAMMONS ENGINEERING —Greensboro, NC
- Full-time
- Travel
- US work authorization
- 2 years
- Paid holidays
- Disability insurance
Quick Apply

Other jobs to consider

Find your next job by exploring related positions.

Diversion Specialist - QP (McDowell/Buncombe/Henderson Co. NC )
Vaya Health —North Carolina
Functions as an independent screener to make the determination of whether an individual has SMI/SPMI; are eligible for Medicaid or state-funded services and are…
$46,302.35 - $60,193.06 a year
5d
Care Manager - LP (Vance County, NC)
Vaya Health —North Carolina
Master’s degree in a field related to health, psychology, sociology, social work, nursing or another relevant human services area.
$62,993.80 - $81,891.99 a year

Show more related jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Clinical Reviewer - Medical Coder & QA
Ohio Living —Westerville, OH
Current unencumbered license for the state of Ohio to practice as a Licenses Practical Nurse (LPN) preferred Certificate for OASIS Specialist-Clinical…
Quick Apply
Board Certified-(M.D, D.O) Ohio Orthopedic Advisor-Certified for IME
Dane Street, LLC —Delaware, OH
Makes telephone calls as mandated by the state and/or client specifics. Identifies, critiques, and utilizes current criteria and resources such as national,…
Quick Apply

I want to receive the latest job alert for utilization management reviewer in greensboro, nc

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

utilization management reviewer jobs near greensboro, nc

Behavioral Specialist jobs in Winston-Salem, NC

Behavioral Specialist jobs in Houston, TX

Blue Ridge Vista Behavioral Health jobs in Cincinnati, OH

Behavioral Specialist jobs in Tyler, TX

Behavioral Assessor jobs in Georgia

Behavioral Specialist jobs in Tulsa, OK

Reading Specialist jobs in Westchester, NY

Behavioral Specialist jobs in Bunnell, FL

Behavioral Specialist jobs in College Station, TX

Behavioral Specialist jobs in Allegheny County, PA

Behavioral Specialist jobs in Great Falls, MT

Government Property Management Specialist jobs in Texas

Behavioral Specialist jobs in Myrtle Beach, SC

Behavioral Health jobs in Charlotte, NC

Program Specialist jobs in Austin, TX

First Year Associate Attorney jobs in New York, NY

Staff Accountant jobs in West Palm Beach, FL

Staff Associate jobs in Atlanta, GA

Staff Associate jobs in Snoqualmie, WA

Staff Associate jobs in California

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

Partners Health Management -
Winston-Salem, NC

Apply Now

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
Appeals
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.

Apply Now

Refine Your Search

utilization management reviewer jobs in greensboro, nc

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

Behavioral Health UM Reviewer (Licensed)-Remote-NC

Staff Associate | Geostructures

Other jobs to consider

Explore jobs in cities nearby

I want to receive the latest job alert for utilization management reviewer in greensboro, nc

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected