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

Santa Barbara Cottage Hospital; United States; Remote; USD 60,000 - 85,000; Full time

Job summary

A leading healthcare organization seeks a dedicated Behavioral Health Utilization Management Care Coordinator to work remotely. The candidate will ensure that clinical information meets medical necessity criteria for service authorization, working with various stakeholders while adhering to regulatory requirements. This full-time position prioritizes candidates with relevant licenses, a Master's degree, and extensive experience in behavioral health.

Benefits

Medical, Dental, Vision plans

Adoption, Fertility and Surrogacy Reimbursement up to $10,000

Paid Time Off and Sick Leave

Paid Parental & Family Caregiver Leave

401k/403B with Employer Match

Tuition Assistance – $5,250/year

Student Debt Pay Down – $10,000

Pet Insurance

Opportunity for discretionary bonus

Qualifications

• Masters Degree in Social Work or Counseling Field OR Bachelor's Degree in Nursing REQUIRED.
• Licensed Clinical Social Worker (LCSW), LPC, LMFT, or RN current license in Virginia REQUIRED.
• 2 years of clinical experience REQUIRED.

Responsibilities

• Review clinical information for Medical Necessity Criteria.
• Ensure accurate data entry for claims processing.
• Navigate compliance with government and insurance payers.

Skills

Clinical Review

Medical Necessity Criteria Knowledge

Regulatory Compliance

Care Coordination

Substance Use Services Knowledge

Education

Masters Degree in Social Work or Counseling

Bachelors Degree in Nursing

Job description

City/State

Norfolk, VA

Work Shift

Weekend Days

Overview:

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

#Ziprecruiter

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

Benefits: Caring For Your Family and Your Career

• Medical, Dental, Vision plans

• Adoption, Fertility and Surrogacy Reimbursement up to $10,000

• Paid Time Off and Sick Leave

• Paid Parental & Family Caregiver Leave

• Emergency Backup Care

• Long-Term, Short-Term Disability, and Critical Illness plans

• Life Insurance

• 401k/403B with Employer Match

• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education

• Student Debt Pay Down – $10,000

• Reimbursement for certifications and free access to complete CEUs and professional development

•Pet Insurance
•Legal Resources Plan
•Colleagues have the opportunity to earn an annual discretionary bonus ifestablished system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work,Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.