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 4x10 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 REQUIREDCertification/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 REQUIREDExperience:2 Years Clinical Experience REQUIRED2 years experience working in behavioral health and 1-year experience with behavioral health care coordination, discharge planning, continuity of care, or transitions of care REQUIRED1 Year Case Management preferredSentara 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 and use the following as your Keyword Search: JR-81602#ZiprecruiterTalroo – Health PlanManaged 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 CarolinaWe provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is:$58,572.80-$97,635.20. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Behavioral Health Utilization Management Care Coordinator (LCSW/LPC/LMFT/RN) - Remote in VA and NC

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