Behavior Health Utilization Management Care Coordinator (Remote)

City/State

Richmond, VA

Overview

Work Shift

First (Days) (United States of America)

Sentara Health is seeking to hire a qualified individual to join our team as a Behavior Health Utilization Management, Care Coordinator. This is a remote position however candidates must reside in the State of Virginia.

The Behavioral Health Utilization Management 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.

Requirements:

• 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.
• 2 years' experience working in behavioral health and 1 years' experience with behavioral health care coordination, discharge planning, continuity of care or transitions of care required. 
• LCSW or LPC or LMFT or RN current license for the state of Virginia. LMHP- S, LMHP-R may be considered if actively working towards licensure and prior experience is present.

This position is 100% remote but candidates must have a current residence in one of the following States or be willing to relocate- Alabama, Delaware, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin, Wyoming

Sentara Health offers employee's comprehensive health care and retirement benefits designed with you and your family's well-being in mind. Our benefits packages are designed to change with you by meeting your needs now and anticipating what comes next. You have a variety of options for medical, dental and vision insurance, life insurance, disability and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave. Team Members have the opportunity to earn an annual flat amount Bonus payment if established system and employee eligibility criteria is met.

For applicants within Washington and Maryland State, the following hiring range will be applied: $62,811.84 to $94,217.76

Keywords: #Indeed, Talroo, RN, LCSW, LPT, Behavioral Health, Care Coordination, Discharge Planning,

Job Summary

Behavioral Health Utilization Management 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.

2 years experience working in behavioral health and 1 years' experience with behavioral health care coordination, discharge planning, continuity of care or transitions of care required.

LCSW or LPC or LMFT or RN current license for the state of Virginia. LMHP- S, LMHP-R may be considered if actively working towards licensure and prior experience is present.

Qualifications:

MLD - Master's Level Degree: Counseling (Required), MLD - Master's Level Degree: Social Work (Required), N-4YR - RN-Bachelor's Level Degree (Required)

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Case Management, Clinical

Skills

Critical Thinking, Microsoft Office, Service Orientation

Sentara Healthcare 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.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

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

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