What are the responsibilities and job description for the Utilization Review Coordinator position at State of North Carolina?
Description of Work
This position is responsible for facilitating the Utilization Review (UR) process and chairing the UR Committee. The UR Coordinator also advises the Utilization Review Committee of any new standards and requirements; and maintains liaison with providers of service to determine whether a resident is receiving active treatment. The position is also responsible for seeking approval of service authorizations from manage care organizations (MCOs) for payment of services and is responsible for ensuring problems with compliance are appropriately resolved.
This position will also ensure Medicaid eligibility for all medical providers thru the NC Tracks portal and ensure active treatment throughout the facility by coordinating and monitoring campus wide observational audits to ensure continuous active treatment for population served.
Work Location: Quality Improvement
Work Hours: 8:00 AM - 5:00 PM
About the Department of Health and Human Services / Caswell Developmental Center: The NC Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, with approximately 18,000 employees. In collaboration with its partners, it is responsible for ensuring the health, safety and well-being of all North Carolinians.
Knowledge, Skills and Abilities / Competencies
- Knowledge of ICF/IID regulatory standards, procedures governing reimbursement of services through MCO, and other regulations as well as policies and procedures of Caswell Developmental Center.
- Excellent communication skills with staff at all levels of the organization.
- Ability to organize and present reports in a clear and concise manner and facilitating and chairing monthly meetings.
- Ability to work independently, observe and complete required facility audits.
- Word processing and use of computer applications (Word, Excel, Outlook) and generating reports/graphs are necessary to fulfill expectations of job.
- Experience working with local Managed Care Organizations (MCOs) and experience with credentialing primary care providers for Medicaid eligibility.
Minimum Education and Experience Requirements
Bachelor's degree in medical record science or medical record administration from an appropriately accredited institution;
or
completion of a human services program with one year of experience in field of training in which six months of training should include experience with documentation;
or
an equivalent combination of education and experience.
Supplemental and Contact Information
The North Carolina Department of Health and Human Services is an Equal Opportunity Employer. Positions in the Division of State Operated Healthcare Facilities shall be subject to pre-employment drug testing and criminal record background checks. Also, the use of tobacco products of any kind including vapor products are prohibited from our campuses. All employees are required to adhere to the facility's Vaccination Policy.
The DHHS Division of Human Resources (DHR) follows the State Human Resources Employment of Relatives Policy. Applicants who have relatives or people living in the same household, will not be considered for job vacancies in the DHR at those locations. For a complete definition of immediate family member, please see the State Human Resources Workforce Planning, Recruitment and Selection Policy, Section 2, Page 38.
Due to the volume of applications received, we are unable to provide information regarding the status of your application over the phone. To check the status of your application, please log in to your account. You will either receive a call to schedule an interview or an email notifying you when the job has been filled.
For technical issues with your applications, please call the NEOGOV Help Line at 855-524-5627. Applicants will be communicated with, via email only, for updates on the status of their application. If there are any questions about this posting other than your application status, please contact HR at (252)208-4293.
Compensation & Benefits:
The State of North Carolina offers excellent comprehensive benefits. Employees can participate in health insurance options, standard and supplemental retirement plans, and the NCFlex program (numerous high-quality, low-cost benefits on a pre-tax basis). Employees also receive paid vacation, sick, and community service leave. In addition, paid parental leave is available to eligible employees. Visit website for State Benefits
NOTE: For temporary, contract or other supplemental staffing appointments: There are no paid leave, retirement or other benefits associated with these appointment types.
For permanent and time-limited appointments:Eligible employees have benefits that include employee health insurance options, standard and supplemental retirement plans, NC Flex (a variety of high-quality, low-cost benefits on a pre-tax basis), and paid vacation, sick, and community service leave, to name a few. Paid parental leave is available for eligible employees. Some benefits require 30 hours work/week for participation.
