Behavioral Health Utilization Management Care Coordinator - Remote VA

Sentara; Norfolk (VA); Remote; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a dedicated Behavioral Health Utilization Management Care Coordinator to join their remote team in Virginia. This pivotal role involves applying critical thinking and clinical expertise to ensure that treatment plans meet necessary criteria for behavioral health services. The ideal candidate will possess a strong background in managed care, evidence-based practices, and a commitment to providing high-quality care. If you are passionate about making a difference in the lives of others and have the required qualifications, this opportunity is perfect for you.

Qualifications

• Requires knowledge of Medicaid and Medicare behavioral health services.
• Experience in behavioral health care coordination and discharge planning.

Responsibilities

• Review clinical information to ensure it meets Medical Necessity Criteria.
• Assess appropriateness of treatment plans across levels of care.

Skills

Critical Thinking

Knowledge of Managed Care Contracting

Clinical Practice Guidelines

Evidence-Based Care

Education

Bachelor of Science in Nursing

Masters of Counseling

Masters of Social Work

Job description

Sentara Health is seeking to hire a qualified individual to join our team as Behavioral Health Utilization Management Care Coordinator.

Position Status: Full-time, Day Shift, Weekends

Position Location: Remote ONLY in the state of Virginia

Standard Working Hours: Friday, Saturday, Sunday, and Monday, 10-hour shifts, can work between the hours of 6:00AM - 6:00PM

Overview

Behavioral Health Utilization Management Care Coordinator applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health outpatient and/or inpatient services, Mental Health Services (MHS), and/or Addiction Recovery and Treatment Services (ARTS). Responsible for reviewing clinical information received from providers ensuring clinical data is substantial enough to meet Medical Necessity Criteria to authorize services as needed. Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, applying evidence-based standards, and practice guidelines to treatment where appropriate. Requires knowledge of managed care contracting, medical necessity, and Medicaid and Medicare behavioral health and substance use services. Knowledge of DMAS protocols, NCQA, CMS, clinical protocols and clinical review requirements.

Education

• Bachelor of Science in Nursing, Masters of Counseling, OR Masters of Social Work Required

Certification/Licensure

• LCSW or LPC or LMFT or RN current license for the state of Virginia

Experience

• 2 years of experience working in behavioral health Required

• 1 year of experience with behavioral health care coordination, discharge planning, continuity of care or transitions of care Required