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

Sentara Health; Virginia; Hybrid; USD 70,000 - 108,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403b with employer match

Paid Time Off

Tuition Assistance

Job summary

Sentara Health is hiring a Board Certified Behavior Analyst (BCBA) for Utilization Management in Virginia, offering a remote, full-time role with standard hours 8am-5pm EST, M-F. Requires BCBA, VA LBA licensure, and 3+ years in health plan or managed care settings.

Responsibilities include coordinating and evaluating treatment appropriateness, applying evidence-based guidelines, and ensuring accurate data entry for claims, with comprehensive benefits. Equal opportunity employer. Remote in VA.

Qualifications

• Master's level degree required.
• Board Certified Behavior Analyst (BCBA) Certification.
• Licensed Behavioral Analyst in Virginia (LBA).
• Knowledge of managed care contracting, medical necessity, Mental Health Services (MHS), behavioral health services, DMAS protocols, clinical protocols, and clinical review requirements.
• ABA (applied behavior analysis) with ASD experience.
• Health Plan experience preferred 3 years of related experience.

Responsibilities

• Interpret criteria, understand complex issues and policies to determine best services.
• Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
• Gather clinical information and apply clinical criteria/guidelines to render coverage.
• Coordinate with providers and other parties to facilitate optimal care and education on clinical necessity.
• Identify members at risk for poor outcomes and facilitate referrals to integrate with other products and programs.
• Promote quality effectiveness of healthcare services and benefit utilization.
• Consult with internal and external constituents in coordination and administration of utilization/benefit management.
• Enter accurate information into claims system for processing of payment.

Job description

City/State Norfolk, VA

Work Shift First (Days)

Overview: 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)
• Licensed Behavioral Analyst in Virginia (LBA)

Experience

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

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

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
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay range for full-time employment is $69,534.40 - $108,056.00 annually. Additional compensation may be available for this role, such as shift differentials, on-call pay, shift premiums, extra-shift incentives, or bonus opportunities. Compensation within the range may vary based on qualifications, experience, location, market conditions, and business needs. Note: If an annual salary is posted, it is based on a full-time colleague working 2,080 hours annually.

Sentara offers a comprehensive benefits package, including medical, dental, vision, life and disability insurance; 401(k)/403(b) with employer match; paid time off (vacation, sick time, and holidays); paid parental and military leave; educational assistance or student loan repayment; and voluntary benefits.

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.

Sentara Health is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!