Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN for Substance Abuse - Flexible Weekend Dayshift - Remote in VA and NC
About The Position
Sentara Health Plans is hiring a Behavioral Health Utilization Management Clinician for Substance Abuse. This is a full-time, permanent position requiring 40 hours per week. The role involves reviewing clinical information from providers to ensure it meets Medical Necessity Criteria for authorizing services. The clinician needs knowledge of medical necessity criteria for behavioral health and substance use services, DMAS protocols, clinical protocols, and clinical review requirements. Additionally, understanding contractual, regulatory, and compliance requirements for various payers is essential. The role also ensures accurate information is entered into the claims system for payment processing.
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
- Valid state license in the state of practice: LCSW (VA or NC), LPC (VA or NC), LMFT (VA or NC), RN Single State (VA or NC), or RN Multi State (VA or NC)
- 2 years of behavioral health REQUIRED
- 1 year of case management REQUIRED
Nice To Haves
- Licensed Substance Abuse Treatment Practitioner (LSATP) OR Certified Substance Abuse Counselor (CSAC) OR Licensed Chemical Dependency Counselors (LCDC) preferred
- Experience in substance abuse in American Society of Addiction Medicine (ASAM) levels of care) and utilization management preferred
Responsibilities
- Review of clinical information received from providers ensuring clinical data is substantial enough to meet Medical Necessity Criteria to authorize services as needed.
- Ensures appropriate and accurate information is entered into 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
- Annual discretionary bonus if established system and employee eligibility criteria is met.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
