Sentara Health Plans is hiring a Behavioral Health Utilization Management Care Coordinator (LCSW/LPC/LMFT/RN) remotely in VA and NC!

Status: Full-time, permanent position (40 hours)

Work hours: Flexible dayshift; Can start from 6am to 9am EST for a 4×10 hour shift (Thursday to Sunday);

Location: Fully remote in Virginia OR Northeast North Carolina.

Job Description Summary:

• 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:

• Masters Degree in Social Work or Counseling Field -or- Bachelors Degree in Nursing 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

Experience:

• 2 Years 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




• 1 Year Case Management preferred