Behavioral Health Utilization Management Clinician

Sentara Health; Norfolk (VA); Remote; USD 60,000 - 80,000; Full time

Job summary

Sentara Health is seeking a qualified Behavioral Health Utilization Management Care Coordinator for a full-time remote role in Virginia. This position involves assessing clinical data to ensure necessary criteria for service authorization are met and requires substantial knowledge of behavioral health protocols and regulations. Ideal candidates hold specific nursing or counseling qualifications and possess relevant clinical experience.

Qualifications

• Requires LCSW or LPC or RN current license for Virginia.
• Minimum of 2 years clinical experience in behavioral health.
• 1-year experience in care coordination or transitions of care.

Responsibilities

• Review clinical information to assess medical necessity.
• Ensure accuracy of claims system data for payment processing.
• Understand regulatory and compliance requirements for payers.

Skills

Clinical Review

Behavioral Health Knowledge

Substance Abuse Management

Utilization Management

Education

Bachelor of Science in Nursing

Master of Counseling

Master of Social Work

Job description

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Sentara Health is seeking to hire a qualified individual to join our team as a Behavioral Health Utilization Management Care Coordinator. Position Status: Full-time, Day Shift, Weekends. Position Location: Remote ONLY in the state of Virginia or North Carolina. Standard Working Hours: Thursday, Friday, Saturday, and Sunday, 10-hour shifts, can start between the hours of 6:00AM - 9:00AM. 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: Bachelor of Science in Nursing, Masters of Counseling, OR Masters of Social Work Required. Certification/Licensure: LCSW or LPC or RN current license for the state of Virginia Required. Experience: 2 years of 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. Must have substance abuse AND utilization management experience.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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