Key Facts

Remote From:

Full time

Expert & Leadership (>10 years)

English

Hard Skills

Care Coordination Art Therapy Medical Necessity Discharge Planning Regulatory Compliance Addiction Treatment Utilization Management Transitional Care Continuing Care Clinical Documentation Clinical Trial Planning Community Mental Health Patient Safety Service Level Management Community Advocacy

Other Skills

•
Communication
•
Teamwork
•
Personal Integrity

Roles & Responsibilities

Educational background: BSN or MS in Counseling, Social Work, or Marriage and Family Therapy
Licensed in Virginia as LCSW, LPC, LMFT, or RN (LMHP-S/R considered if actively pursuing licensure and relevant experience)
Minimum 2 years of behavioral health experience and 1 year of case management; at least 1 year of substance use treatment experience
Certified Substance Abuse Counselor (CSAC) preferred but not required

Requirements:

Review clinical information from providers to determine medical necessity and authorize ARTS services as needed
Ensure documentation meets Medical Necessity Criteria and DMAS/care management requirements; apply regulatory and contractual guidelines
Enter accurate information into the claims system to support processing and payment; navigate payer rules and contract requirements
Coordinate care across behavioral health and ARTS services, support transitions of care, and communicate with providers, members, and care teams

Sentara Healthcare

About Sentara Healthcare

Sentara Health celebrates a 130-year history of innovation, compassion, and community benefit. Based in Norfolk, VA, Sentara is a diverse not-for-profit family of 12 hospitals, an array of integrated services, and a team of nearly 30,000 strong on a mission to improve health every day. This is pursued through a disciplined strategy to achieve Top 10% performance in key measures through shared best practices, transformation of primary care through clinical integration and strategic growth that adds value to the communities we serve in Virginia and North Carolina. Like us on Facebook at www.facebook.com/sentarahealth Follow us on Instagram at @SentaraHealth

Company type: XLarge

Founded: 2018

Company size: 10001

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Job description

City/State

Norfolk, VA

Work Shift

First (Days)

Overview:

Sentara Health is currently seeking a full-time remote Addiction and Recovery Treatment Services (ARTS) Care Coordinator in Virginia!.

Position Status: Full-time, Day Shift

Position Location: Remote in the state of Virginia

Standard Working Hours: Monday - Friday, 8:00AM - 5:00PM EST.

Overview

The Addiction and Recovery Treatment Services (ARTS) Care Coordinator 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 managed care contracting, Medical Necessity, CMHRS services, BH and ARTS 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, OR Marriage and Family Therapy REQUIRED

Certification/Licensure

Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC) or Licensed Marriage and Family Therapist (LMFT) or Registered Nurse License (RN) current license for the state of Virginia REQUIRED
LMHP- S, LMHP-R may be considered if actively working towards licensure and prior experience is present.

Experience

2 years of behavioral health REQUIRED
1 year of case management REQUIRED
Must have at least 1 year experience with substance use
Certified Substance Abuse Counselor (CSAC) preferred, but not required.

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-96131

#Indeed

Talroo – Health Plan

Keywords: Managed Care, MCO, Health Plan, Healthcare, Masters, Social Work, Counseling Field, BSN, Bachelor's, Nursing, Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Registered Nurse License (RN), Clinical, behavioral health, care coordination, discharge planning, continuity of care, transitions of care, Remote, Virginia, Addiction and Recovery Treatment Services (ARTS), Medicaid, Certified Substance Abuse Counselor (CSAC)

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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