Board Certified Behavior Analyst (BCBA)/Behavioral Health Utilization Management

Sentara Health•Virginia Remote, VA

7d•Remote

About The Position

Sentara Health is hiring for a Board Certified Behavior Analyst (BCBA) Utilization Management Professional to apply critical thinking and expertise in clinically appropriate treatment, evidence-based care, and clinical practice guidelines for Behavioral Health, specifically in Behavior Analysis. This role involves assessing the appropriateness of treatment plans across different levels of care, applying evidence-based standards and practice guidelines where applicable. The professional will utilize clinical knowledge, communication skills, and independent critical thinking to interpret criteria, understand complex issues and policies, and determine the most appropriate services. They will coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members, gather clinical information, and apply clinical criteria, guidelines, policies, and procedures to render coverage decisions. This role also involves coordinating with providers and other parties to facilitate optimal care, educate on clinical necessity concerns, and ensure Applied Behavior Analysis (ABA) compliance. Additionally, the professional will identify members at risk for poor outcomes, facilitate referral opportunities, promote quality and effectiveness of healthcare services, and consult with internal and external constituents. Accurate information entry into the claims system for payment processing is also a key responsibility.

Requirements

Master's Level Degree REQUIRED
Board Certified Behavior Analyst (BCBA) REQUIRED
Licensed Behavioral Analyst in Virginia (LBA) REQUIRED
Knowledge of managed care contracting, medical necessity, Mental Health Services (MHS), behavioral health services, DMAS protocols, clinical protocols, and clinical review requirements REQUIRED
Knowledge of contractual, regulatory and compliance requirements for government payers, self-funded and commercial payers REQUIRED
ABA (applied behavior analysis) with ASD (autism spectrum disorder) experience REQUIRED
3 years of related experience REQUIRED

Nice To Haves

Health Plan experience preferred

Responsibilities

Uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, understanding complex issues and policies and procedures to determine the best and most appropriate services.
Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members.
Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage.
Coordinates with providers and other parties to facilitate optimal care/treatment and treatment and to educate and address clinical necessity concerns and ABA (applied behavior analysis) compliance requirements.
Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.
Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.
Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
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
Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.