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Award-winning: Sentara is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering more than 500 sites of care including 12 hospitals, PACE (Elder Care), home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!
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
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Bachelor of Science in Nursing, Masters of Counseling, OR Masters of Social Work Required
Certification/Licensure
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LCSW or LPC or RN current license for the state of Virginia Required
Experience
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2 years of clinical experience Required
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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
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Must have substance abuse AND utilization management experience
Sentara 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.
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