IDD UM Monitoring Specialist

LOCATION: Remote - must live in North Carolina or within 40 miles of the NC border.

GENERAL STATEMENT OF JOB

This position provides data monitoring and coordination support for the Utilization Management Department with primary focus on members with an Intellectual and/or Developmental Disability (IDD) receiving Innovations Waiver services. Interacts with staff, providers, stakeholders and the public, providing information and other forms of assistance to them.

ESSENTIAL JOB FUNCTIONS

N.C. Innovations Waiver Claims Monitoring

• Responsible for the monthly data reports and analysis of budgets for participants and claims to identify areas of over/under utilization.
• Review claims submitted by provider(s) to ensure the individual is receiving services as outlined in the plan of care and/or to identify potential service deviations.
• Coordinate documentation of identified concerns, Care Management referral, and resolution.

Intensive Review Committee and Resource Allocation Support

• Responsible for all administrative functions related to the Resource Allocation (RA) process to include data review, follow-up for missing information, merging data files, creation of RA letters, mail merge capabilities, uploading files to member records and uploading to shared data site.
• Coordinate with Vaya MIS team, clinical lead, and care coordination staff on monthly basis.
• Coordinate and support to the monthly Intensive Review Committee, facilitated by the IDD UM Manager.
• Coordinate with issuance of notification of determination following the review from Intensive Review Committee (IRC) when.

Innovations Waiver Allocation Notifications

Innovations Pre-payment Forms

Other Duties

KNOWLEDGE, SKILL & ABILITIES:

• Knowledge of federal and state laws, rules and regulations governing confidentiality, privacy and security of sensitive information required.
• Knowledge related to accessing a wide range of information from a variety of sources including on site documentation as well as external resources.
• Familiarity with a wide variety of software packages, and the electronic medical record.
• Strong interpersonal skills are required in dealing with staff at all levels, clients and the general population.
• Skilled in organizing workflow and strong detail orientation.
• Ability to analyze and interpret policy and procedural guidelines.
• Intermediate level Microsoft Office procedure proficiency required.
• Excellent verbal and written skills.

QUALIFICATIONS & EDUCATION REQUIREMENTS

• A High School Diploma or GED and four years of progressive responsibilities in secretarial or clerical/administrative/office management experience

OR

• An Associate or Bachelor's Degree and two years of progressive responsibilities in secretarial or clerical/administrative/office management experience

PHYSICAL REQUIREMENTS:

• Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading.
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers.
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
• Mental concentration is required in all aspects of work.

RESIDENCY REQUIREMENTS: The person in this position is required to reside in North Carolina or within 40 miles of the NC border.

SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open Until Filled

APPLY: Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.

Vaya Health is an equal opportunity employer.