Offer summary

Qualifications:

Bachelor of Science in Nursing, Masters of Counseling, or Masters of Social Work required., Current LCSW, LPC, or RN license for Virginia is mandatory., Minimum of 2 years of clinical experience in behavioral health is essential., Experience in substance abuse and utilization management is necessary. .

Key responsibilities:

Review clinical information from providers to ensure it meets Medical Necessity Criteria for service authorization.

Enter accurate information into the claims system for payment processing.

Ensure compliance with contractual, regulatory, and clinical review requirements.

Coordinate care transitions and discharge planning for behavioral health services.

Job description

City/State

Norfolk, VA

Work Shift

Weekend Days

Overview:

Sentara Health is seeking to hire a qualified individual to join our team as a Behavioral Health Utilization Management Care Coordinator.

Position Status: Full-time, Day Shift, Weekends

Position Location: Remote ONLY in the state of Virginia or North Carolina

Standard Working Hours: Thursday, Friday, Saturday, and Sunday, 10-hour shifts, can start between the hours of 6:00AM - 9:00AM

Overview

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. Requires knowledge of medical necessity criteria for behavioral health and substance use services, DMAS protocols, clinical protocols and clinical review requirements. Requires knowledge of contractual, regulatory and compliance requirements for government payers, self-funded and commercial payers. Ensures appropriate and accurate information is entered into claims system for processing of payment.

Education

Bachelor of Science in Nursing, Masters of Counseling, OR Masters of Social Work Required

Certification/Licensure

LCSW or LPC or RN current license for the state of Virginia Required

Experience

2 years of clinical experience Required
2 years experience working in behavioral health and 1-year experience with behavioral health care coordination, discharge planning, continuity of care, or transitions of care
Required
Must have substance abuse AND utilization management experience

Benefits: Caring For Your Family and Your Career

• 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
•Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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