Behavioral Health Utilization Management Clinician - Remote VA and NC at Sentara Health

, Virginia, United States -

Full Time

Start Date

Immediate

Expiry Date

02 Jan, 26

Salary

0.0

Posted On

04 Oct, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Behavioral Health, Substance Use Services, Medical Necessity Criteria, Clinical Protocols, Discharge Planning, Continuity of Care, Transitions of Care, Utilization Management, Claims Processing, Regulatory Compliance, Care Coordination, Clinical Review, LCSW, LPC, LMFT, RN

Industry

Hospitals and Health Care

Description

City/State Norfolk, VA Work Shift First (Days) Overview: 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 Overview 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, OR Marriage and Family Therapy Required Certification/Licensure LCSW or LPC or LMFT or RN current license for the state of VA or NC 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 Benefits: Caring For Your Family and Your Career • 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. 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!

Responsibilities

The Behavioral Health Utilization Management Clinician is responsible for reviewing clinical information from providers to ensure it meets Medical Necessity Criteria for service authorization. This role requires knowledge of behavioral health and substance use services, as well as compliance with various payer requirements.