Inpatient Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN - Remote in VA and NC
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 services. The role requires knowledge of behavioral health and substance use service criteria, DMAS protocols, clinical protocols, and clinical review requirements, as well as contractual, regulatory, and compliance requirements for various payers. The clinician will ensure accurate information is entered into the claims system for payment processing.
Requirements
- Master’s degree in Counseling, Social Work, or Marriage and Family Therapy OR Bachelor of Science in nursing.
- Valid state license in the state of practice (Virginia or North Carolina).
- Licensed Clinical Social Worker (LCSW) OR Licensed Professional Counselor (LPC) OR Licensed Marriage and Family Therapist (LMFT) OR Registered Nurse (RN) OR Licensed Substance Abuse Treatment Practitioner (LSATP) OR Certified Substance Abuse Counselor (CSAC) OR Licensed Chemical Dependency Counselors (LCDC).
- 2 years of behavioral health experience.
- 1 year of case management experience.
Nice To Haves
- Inpatient Behavioral Health experience.
- Health plan experience.
- LSATP, CSAC, or LCDC certification/license.
Responsibilities
- Review clinical information received from providers.
- Ensure clinical data is substantial enough to meet Medical Necessity Criteria to authorize services.
- Ensure 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
