Behavioral Health Utilization Management Clinician - Remote VA and NC

Sentara Health • VA

117d

About The Position

Sentara Health is seeking to hire a qualified individual to join our team as a Behavioral Health Utilization Management Care Coordinator. The 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. This position requires knowledge of medical necessity criteria for behavioral health and substance use services, DMAS protocols, clinical protocols and clinical review requirements. It also requires knowledge of contractual, regulatory and compliance requirements for government payers, self-funded and commercial payers. The clinician ensures appropriate and accurate information is entered into claims system for processing of payment.

Requirements

• Bachelor of Science in Nursing, Masters of Counseling, or Masters of Social Work.
• Current LCSW, LPC, or RN license for the state of Virginia.
• 2 years of clinical experience.
• 2 years of experience working in behavioral health.
• 1 year of experience with behavioral health care coordination, discharge planning, continuity of care, or transitions of care.
• Experience in substance abuse and utilization management.

Responsibilities

• Review clinical information from providers to ensure it meets Medical Necessity Criteria.
• Authorize services based on clinical data.
• Ensure compliance with DMAS protocols and clinical review requirements.
• Enter accurate information into claims system for payment processing.

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.
• Annual discretionary bonus eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees