Inpatient Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN - Remote in VA and NC

Sentara Health • Norfolk, VA

8d • Remote

About The Position

Sentara Health Plans is hiring a remote Inpatient Behavioral Health Utilization Management Clinician for Virginia and North Carolina. This full-time, permanent position involves reviewing clinical information from providers to ensure it meets Medical Necessity Criteria for authorizing behavioral health and substance use services. The role requires knowledge of medical necessity criteria, DMAS protocols, clinical protocols, and regulatory requirements for various payers. Accurate data entry into the claims system for payment processing is also a key responsibility.

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 license in state of practice: LCSW (VA or NC), LPC (VA or NC), LMFT (VA or NC), RN (VA or NC), LSATP
• 2 years of behavioral health REQUIRED
• 1 year of case management REQUIRED

Nice To Haves

• Certified Substance Abuse Counselor (CSAC) or Licensed Chemical Dependency Counselors (LCDC) preferred
• Inpatient Behavioral Health and health plan experience 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level