Behavioral Health Utilization Management Clinician - Remote VA and NC

Sentara; North Carolina; Remote; USD 10,000 - 60,000; Full time

Job summary

A healthcare organization is seeking a Behavioral Health Utilization Management Care Coordinator to work remotely in Virginia or North Carolina. Responsibilities include reviewing clinical data for medical necessity and ensuring compliance with regulations. Candidates must have relevant clinical experience and appropriate licenses. Offers a comprehensive benefits package, including medical plans and tuition assistance.

Benefits

Medical, Dental, Vision plans

Tuition Assistance - $5,250/year

401k/403B with Employer Match

Pet Insurance

Qualifications

• 2+ years of clinical experience in behavioral health.
• LCSW or LPC current license for Virginia required.

Responsibilities

• Review clinical information ensuring medical necessity.
• Maintain compliance with regulatory and contractual requirements.
• Enter accurate information into claims system.

Skills

Knowledge of medical necessity criteria

Behavioral health and substance use services

Utilization management experience

Case coordination

Education

Bachelor of Science in Nursing or relevant master's degree

Job description

Overview

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

City/State: Norfolk, VA

Work Shift: First (Days)

Position Details

Position Status: Full-time, Day Shift

Position Location: Remote ONLY in the state of Virginia or North Carolina

Standard Working Hours: M-F, 8 hour shift, can start between the hours of 6:00AM - 9:00AM EST

Responsibilities

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

About Sentara Health Plans

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-86481

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
• 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 if established 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.