Overview:

Sentara Health Plans is hiring a Inpatient Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN

Remote in VA and NC!

Status:

Full-time, permanent position (40 hours) Work hours: Flexible dayshift; Can start from 6am to 9am

EST, M-F

Location:

Fully remote in Virginia OR North Carolina. 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 Master's degree in Counseling, Social Work, or Marriage and Family Therapy

REQUIRED

For Registered Nurses, a Bachelor of Science in nursing is

REQUIRED

Certification/Licensure

REQUIRED

license must be valid in state of practice.

One of the following qualifies:

Licensed Clinical Social Worker (LCSW)

State license
Virginia Department of Health Professionals (VADHP) OR Licensed Clinical Social Worker (LCSW)
State license
North Carolina Social Work Certification and Licensure Board (NCSWCLB) OR Licensed Professional Counselor (LPC)
State license
Virginia Department of Health Professionals (VADHP) OR Licensed Professional Counselor (LPC)
State license
North Carolina Board of Licensed Clinical Mental Health Counselors (NCBLCMHC) OR Licensed Marriage and Family Therapist (LMFT)
State license
Virginia Department of Health Professionals (VADHP) OR Licensed Marriage and Family Therapist (LMFT)
State license
North Carolina Marriage and Family Therapy Licensure Board (NCBMFT) OR Registered Nurse (RN) Single State
Nursing License
Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Single State
Nursing License
North Carolina Board of Nursing (NCBON) OR Registered Nurse (RN) Multi State
Nursing License
Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Multi State
Nursing License
North Carolina Board of Nursing (NCBON) OR Licensed Substance Abuse Treatment Practitioner (LSATP) Certified Substance Abuse Counselor (CSAC) OR Licensed Chemical Dependency Counselors (LCDC) preferred Experience 2 years of behavioral health

REQUIRED 1

year of case management

REQUIRED

Inpatient Behavioral Health and health plan experience preferred 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-104143

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, Days, North Carolina 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
Reimbursement for certifications and free access to complete CEUs and professional development
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. 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