Behavioral Health Whole Person Care Hybrid-Central

Sentara Health • Fredericksburg, VA

7d • Hybrid

About The Position

Behavioral Health Utilization Management Care Coordinator 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 managed care contracting, Medical Necessity, CMHRS services, BH and ARTS 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 the claims system for processing of payment. 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! 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!

Requirements

• Master’s degree in Counseling, Social Work, or Marriage and Family Therapy required. For Registered Nurses, a Bachelor of Science in nursing is required.
• Required license must be valid in state of practice. One of the following qualifies: Licensed Clinical Social Worker (LCSW) - State license - Virginia Department of Health Professionals (VADHP) OR Licensed Clinical Social Worker (LCSW) - State license - North Carolina Social Work Certification and Licensure Board (NCSWCLB) OR Licensed Professional Counselor (LPC) - State license - Virginia Department of Health Professionals (VADHP) OR Licensed Professional Counselor (LPC) - State license - North Carolina Board of Licensed Clinical Mental Health Counselors (NCBLCMHC) OR Licensed Marriage and Family Therapist (LMFT) - State license - Virginia Department of Health Professionals (VADHP) OR Licensed Marriage and Family Therapist (LMFT) - State license - North Carolina Marriage and Family Therapy Licensure Board (NCBMFT) OR Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Single State - Nursing License - North Carolina Board of Nursing (NCBON) OR Registered Nurse (RN) Multi State - Nursing License - Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Multi State - Nursing License - North Carolina Board of Nursing (NCBON)
• 2 years of behavioral health (Required)
• 1 year of case management (Required)

Responsibilities

• review of clinical information received from providers ensuring clinical data is substantial enough to meet Medical Necessity Criteria to authorize services as needed
• knowledge of managed care contracting, Medical Necessity, CMHRS services, BH and ARTS services, DMAS protocols, clinical protocols and clinical review requirements
• knowledge of contractual, regulatory and compliance requirements for government payers, self-funded and commercial payers
• Ensures appropriate and accurate information is entered into the claims system for processing of payment

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees