Utilization Review Coordinator

Salary : $41,857.00 - $62,786.00 Annually

Location : Lenoir County, NC

Job Type : Permanent Full-Time

Job Number : 25-01743

Department : Dept of Health and Human Services

Division : Caswell Developmental Center

Opening Date : 02 / 06 / 2025

Closing Date : 2 / 13 / 2025 5 : 00 PM Eastern

Job Class Title : Patient Review Coordinator

Position Number : 60053540

Salary Grade : MH08

Description of Work

This is an anticipated vacancy.

The primary purpose of this position at Caswell Developmental Center is to facilitate the review of resident records against established criteria for maintaining intermediate care facility (ICF) and Medicaid standards / eligibility for all residents. It involves consulting with the attending physician when documentation does not reflect established criteria for services.

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.

Caswell Developmental Center, serving as North Carolina's Eastern Region resource center, provides specialized residential, programmatic, and support services for individuals with developmental disabilities. The individuals we serve are at the heart of our facility. Our team is critical to the mission of the facility. We strive to create an environment in which every team member contributes to the overall success of the Center to positively impact the lives of those around them and the individuals we service. If you are looking to make a difference and seeking a rewarding career, we encourage you to consider this opportunity. Please click on the following link https : / / vimeo.com / 185000006 to experience how Caring is Contagious at Caswell Developmental Center.

Knowledge, Skills and Abilities / Competencies

To receive credit for all your work history and credentials, you must list the information on the application form. Any information listed under the text resume section or on an attachment will not be considered for qualifying credit. Qualified candidates must document on the application that they clearly possess all the following :

• 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.

Management Preferences :

Minimum Education and Experience Requirements

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

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.

Where did you learn about DHHS or this opportunity?

Please give additional detail where you learned of DHHS or this opportunity. (e.g., APA Annual Meeting in NYC in May 2018, Facebook, Doximity, NC Substance Abuse Professional Practice Board, etc.)

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Salary : $41,857 - $62,786