Board Certified Behavior Analyst (BCBA)/Behavioral Health Utilization Management Sentara Health Administration, Inc. Norfolk, VA Job Details Full-time 8 hours ago Benefits 403(b) matching Paid parental leave Caregiver leave Disability insurance Health insurance Dental insurance Tuition reimbursement Paid time off Parental leave Vision insurance 401(k) matching 403(b) Life insurance Pet insurance Qualifications Experience working with children with autism spectrum disorder (ASD) Utilization review Managed care organization experience Health insurance policy knowledge Regulatory compliance Experience working with individuals with autism Master's degree Licensed Behavior Analyst Utilization management Medical treatment knowledge Board Certified Behavior Analyst Working with individuals with mental health conditions Autism spectrum disorders support Medical billing regulations compliance Legal compliance Health insurance management Full Job Description City/State Norfolk, VA Work Shift First (Days)

Overview:

Sentara Health is hiring for a Board Certified Behavior Analyst (BCBA)/Behavioral Health Utilization Management

•Remote in VA!

Status:

Full-Time, permanent position (40 hours) Standard working hours: 8am to 5pm

EST, M-F.

Location:

Remote in Virginia only

Job Profile Summary:

Board Certified Behavior Analyst (BCBA) Utilization Management Professional applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health, specific to Behavior Analysis. Utilizes clinical experience and skills in a collaborative process to assess appropriateness of treatment plans across levels of care, applying evidence-based standards, and practice guidelines to treatment where appropriate. Uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, understanding complex issues and policies and procedures to determine the best and most appropriate services. Coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage. Coordinates with providers and other parties to facilitate optimal care/treatment and treatment and to educate and address clinical necessity concerns and ABA (applied behavior analysis) compliance requirements. Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs. Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Ensures appropriate and accurate information is entered into the claims system for processing of payment.

Education:

MLD

•Master's Level Degree

REQUIRED

Certification/Licensure:

Board Certified Behavior Analyst (BCBA)

REQUIRED

Licensed Behavioral Analyst in Virginia (LBA)

REQUIRED

Experience:

Knowledge of managed care contracting, medical necessity, Mental Health Services (MHS), behavioral health services, DMAS protocols, clinical protocols, and clinical review requirements

REQUIRED

Knowledge of contractual, regulatory and compliance requirements for government payers, self-funded and commercial payers

REQUIRED ABA

(applied behavior analysis) with ASD (autism spectrum disorder) experience

REQUIRED

Health Plan experience preferred 3 years of related experience

REQUIRED

Keywords:

Talroo

•Health Plan, Remote, VA, Virginia, Healthcare, Health Plan, MCO, Managed Care, Behavioral Health, Mental, Psych, BH, Utilization Management, UM, ABA, Applied behavior analysis, ASD, autism spectrum disorder,

Mental Health Services, MHS, DMAS, Licensed Behavioral Analyst, LBA, BCBA 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 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.