Behavioral Health Utilization Management Care Coordinator (LCSW/LPC/LMFT/RN) - Remote in VA and NC

Sentara Healthcare Inc; Norfolk (VA); Remote; USD 60,000 - 75,000; Full time

Job summary

Sentara Health Plans is seeking a Behavioral Health Utilization Management Care Coordinator. This full-time, remote role requires a Master's degree in social work or counseling and experience in behavioral health. You will conduct clinical reviews ensuring services meet established criteria, impacting the quality of care for members across Virginia.

Qualifications

• Masters in Social Work or Counseling or BSN required.
• LCSW, LPC, LMFT, or RN license in Virginia needed.
• 2 years clinical experience required.

Responsibilities

• Review clinical information to ensure it meets Medical Necessity criteria.
• Ensure accurate claims processing information is entered.
• Knowledge of DMAS and behavioral health service protocols required.

Skills

Knowledge of medical necessity criteria

Knowledge of clinical protocols

Knowledge of compliance requirements

Education

Masters Degree in Social Work or Counseling Field

Bachelors Degree in Nursing

Job description

Sentara Health Plans is hiring a Behavioral Health Utilization Management Care Coordinator (LCSW/LPC/LMFT/RN) remotely in VA and NC!

Status: Full-time, permanent position (40 hours)

Work hours: Flexible dayshift; Can start from 6am to 9am EST for a 4x10 hour shift (Thursday to Sunday);

Location: Fully remote in Virginia OR Northeast North Carolina.

Job Description Summary:

• Behavioral Health Utilization Management clinician is responsible for review of clinical information received from providers ensuring clinical data is substantial enough to meet Medical Necessity Criteria to authorize services as needed.

• Requires knowledge of medical necessity criteria for behavioral health and substance use services, DMAS protocols, clinical protocols and clinical review requirements.

• Requires knowledge of contractual, regulatory and compliance requirements for government payers, self-funded and commercial payers.

• Ensures appropriate and accurate information is entered into claims system for processing of payment.

Education:

• Masters Degree in Social Work or Counseling Field -or- Bachelors Degree in Nursing REQUIRED

Certification/Licensure:

• Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC) or Licensed Marriage and Family Therapist (LMFT) or Registered Nurse License (RN) current license for the state of Virginia REQUIRED

Experience:

• 2 Years Clinical Experience REQUIRED

• 2 years experience working in behavioral health and 1-year experience with behavioral health care coordination, discharge planning, continuity of care, or transitions of care REQUIRED

• 1 Year Case Management preferred

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-81602

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Talroo – Health Plan

Managed Care, MCO, Health Plan, Healthcare, Masters, Social Work, Counseling Field, BSN, Nursing, Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Registered Nurse License (RN), Clinical, behavioral health, care coordination, discharge planning, continuity of care, transitions of care, Remote, Virginia, Weekends, Days, North Carolina