Behavioral Health Utilization Management Clinician - Remote VA and NC

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, Position Location: Remote ONLY in the state of Virginia or North Carolina Standard Working Hours: M-F, 8 hour shift, can start between the hours of 6:00AM - 9:00AM EST 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 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-86481 #Indeed Talroo – Health Plan Managed Care, MCO, Health Plan, Healthcare, Masters, Social Work, Counseling Field, BSN, 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, Weekends, Days, North Carolina Apply tot his job