Behavioral Health Utilization Management Care Coordinator - Remote VA

Santa Barbara Cottage Hospital; United States; 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 innovative team. This role involves applying critical thinking and expertise in evidence-based care to ensure the highest quality of behavioral health services. The position requires a strong understanding of managed care contracting and clinical review requirements, making it essential for candidates to have a solid background in behavioral health. With a commitment to diversity and inclusiveness, this organization offers a supportive environment for both personal and professional growth. Join a team that values your contributions and supports your career aspirations.

Benefits

Medical, Dental, Vision plans

Tuition Assistance up to $5,250/year

401k/403B with Employer Match

Paid Time Off and Sick Leave

Pet Insurance

Emergency Backup Care

Legal Resources Plan

Reimbursement for certifications

Opportunity to earn an annual discretionary bonus

Student Debt Pay Down of $10,000

Qualifications

• Minimum 2 years in behavioral health required.
• At least 1 year in care coordination or discharge planning.

Responsibilities

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

Skills

Critical Thinking

Knowledge of Evidence-Based Care

Understanding Managed Care Contracting

Clinical Review Requirements

Education

Bachelor of Science in Nursing

Masters of Counseling

Masters of Social Work

Job description

City/State

Norfolk, VA

Work Shift

Weekend Days

Overview:

Sentara Health is seeking to hire a qualified individual for the position of Behavioral Health Utilization Management Care Coordinator.

Position Details:

• Status: Full-time, Day Shift, Weekends
• Location: Remote ONLY in Virginia
• Working Hours: Friday to Monday, 10-hour shifts between 6:00 AM - 6:00 PM

Responsibilities:

The 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 inpatient services, Mental Health Services (MHS), and Addiction Recovery and Treatment Services (ARTS). Responsibilities include reviewing clinical information from providers to ensure it meets Medical Necessity Criteria for service authorization. The role requires assessing treatment plan appropriateness across levels of care, using evidence-based standards and practice guidelines, and understanding managed care contracting, medical necessity, and Medicaid and Medicare behavioral health services. Knowledge of DMAS protocols, NCQA, CMS, and clinical review requirements is essential.

Education Requirements:

• Bachelor of Science in Nursing, Masters of Counseling, or Masters of Social Work (Required)

Certification/Licensure:

• LCSW, LPC, LMFT, or RN license for Virginia (Current)

Experience:

• Minimum 2 years in behavioral health (Required)
• At least 1 year in behavioral health care coordination, discharge planning, or transitions of care (Required)

Benefits: Caring For Your Family and Your Career

• Medical, Dental, Vision plans
• Reimbursement for Adoption, Fertility, and Surrogacy 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 up to $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down of $10,000
• Reimbursement for certifications and access to CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Opportunity to earn an annual discretionary bonus based on system and employee eligibility criteria

Sentara Health is an equal opportunity employer that values diversity and inclusiveness within its nearly 30,000-member workforce. Diversity, inclusion, and belonging are core principles to ensure the workforce reflects the communities served.

This is a tobacco-free environment supporting our mission “to improve health every day.”

Remote Work Eligibility: Sentara Health employs associates in several states, including Virginia, North Carolina, and others listed in the original description.