Behavioral Health Utilization Management Care Coordinator- Person Care Residential Fa

Sentara Health Plans – Behavioral Health Utilization Management Care Coordinator (Whole Person Care for Residential Facilities) – Hybrid in Central Virginia (Richmond, Petersburg)

Position Status:
Full-time, permanent (40 hours/week)

Position Location:
Central Virginia (Richmond, Petersburg). This is a hybrid role with travel up to approximately 2 days per week to residential facilities in Central Virginia (Richmond, Petersburg) and 3 days working from home.

Standard

Working Hours:

8 AM to 5 PM EST, M-F

Behavioral Health Utilization Management Care Coordinator is responsible for review of clinical information received from providers to ensure 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 the claims system for processing of payment.

• Master’s degree in Counseling, Social Work, or Marriage and Family Therapy required. For Registered Nurses, a Bachelor of Science in Nursing is required.

Required license must be valid in the state of practice. One of the following qualifies:

• Licensed Clinical Social Worker (LCSW) – State license - Virginia Department of Health Professionals (VDHP) OR Licensed Clinical Social Worker (LCSW) - North Carolina Social Work Certification and Licensure Board (NCSWCLB)
• Licensed Professional Counselor (LPC) – State license - VDHP OR Licensed Professional Counselor (LPC) - North Carolina Board of Licensed Clinical Mental Health Counselors (NCBLCMHC)
• Licensed Marriage and Family Therapist (LMFT) – State license - VDHP OR Licensed Marriage and Family Therapist (LMFT) - North Carolina Marriage and Family Therapy Licensure Board (NCMFMT)
• Registered Nurse (RN) Single State – Nursing License - VDHP OR Registered Nurse (RN) Single State – North Carolina Board of Nursing (NCBON)
• Registered Nurse (RN) Multi State – Nursing License - VDHP OR Registered Nurse (RN) Multi State – North Carolina Board of Nursing (NCBON)

• 2 years of behavioral health (Required)
• 1 year of case management (Required)
• Experience in a residential facility is 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 and use the following as your Keyword Search:
JR-93117

#Indeed

Talroo – Health Plan