Board Certified Behavior Analyst (BCBA)/Behavioral Health Utilization Management

Sentara Healthcare Inc; Norfolk (VA); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Sentara Health in Virginia offers a full-time, remote BCBA Utilization Management role focused on behavioral health services and committee-based care decisions. You will assess treatment appropriateness across care levels, leveraging evidence-based guidelines and clinical judgment.

The position requires a Master's level degree, BCBA certification, and Virginia LBA licensure, with 3+ years of related experience in managed care and ASD ABA settings. Remote work is available to VA residents.

Qualifications

• Master's degree required.
• BCBA certification required.
• Virginia Licensed Behavior Analyst (LBA) required.

Responsibilities

• Interpret criteria and policies to determine best services.
• Coordinate and monitor options for appropriate healthcare services.
• Gather clinical information and apply guidelines for coverage decisions.
• Coordinate with providers to facilitate optimal care and ABA compliance.
• Identify at-risk members and promote referrals to integrate with programs.
• Identify opportunities to improve quality and utilization of services.
• Lend clinical expertise to internal and external stakeholders in UM functions.
• Ensure accurate information is entered into claims systems for processing.

Skills

Clinical knowledge

Communication skills

Critical thinking

Education

Master's Degree

Job description

Sentara Health is hiring for a Board Certified Behavior Analyst (BCBA)/Behavioral Health Utilization Management- Remote in VA!

Status: Full-Time,permanent position (40 hours)

Standard working hours: 8am to 5pm EST, M-F.

Location: Remote in Virginia only

Job Profile Summary:

Board Certified Behavior Analyst (BCBA) Utilization Management Professional applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health, specific to Behavior Analysis. 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.

Job Description:

• Uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, understanding complex issues and policies and procedures to determine the best and most appropriate services.
• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage.
• Coordinates with providers and other parties to facilitate optimal care/treatment and treatment and to educate and address clinical necessity concerns and ABA (applied behavior analysis) compliance requirements.
• Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.
• Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
• Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
• Ensures appropriate and accurate information is entered into the claims system for processing of payment.

Education:

• MLD - Master's Level Degree REQUIRED

Certification/Licensure:

• Board Certified Behavior Analyst (BCBA) REQUIRED
• Licensed Behavioral Analyst in Virginia (LBA) REQUIRED

Experience:

• Knowledge of managed care contracting, medical necessity, Mental Health Services (MHS), behavioral health services, DMAS protocols, clinical protocols, and clinical review requirements REQUIRED
• Knowledge of contractual, regulatory and compliance requirements for government payers, self-funded and commercial payers REQUIRED
• ABA (applied behavior analysis) with ASD (autism spectrum disorder) experience REQUIRED
• Health Plan experience preferred
• 3 years of related experience REQUIRED

Keywords: Talroo- Health Plan, Remote, VA, Virginia, Healthcare, Health Plan, MCO, Managed Care, Behavioral Health, Mental, Psych, BH, Utilization Management, UM, ABA, Applied behavior analysis, ASD, autism spectrum disorder, Mental Health Services, MHS, DMAS, Licensed Behavioral Analyst, LBA, BCBA