Remote BCBA Utilization Manager – Behavioral Health

170 Sentara Health Administration, Inc.; 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

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.