Sentara Health is seeking to hire a qualified individual to join our team as a Behavioral Health Utilization Management Care Coordinator.
Position Status: Full-time, Day Shift, Weekends
Position Location: Remote ONLY in the state of Virginia or North Carolina
Standard Working Hours: Thursday, Friday, Saturday, and Sunday, 10-hour shifts, can start between the hours of 6:00AM – 9:00AM
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
Bachelor of Science in Nursing, Masters of Counseling, OR Masters of Social Work Required
Certification/Licensure
LCSW or LPC or RN current license for the state of Virginia Required
Experience
2 years of 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
Must have substance abuse AND utilization management experience
We 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.
Sentara Health
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