Behavioral Health Utilization Management Care Coordinator- Person Care Residential Fa

Overview

Behavioral Health Utilization Management Care Coordinator 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 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.

Hybrid role based in Winchester, VA; travel approximately 2 days per week to residential facilities and 3 days working from home.

Standard

Working Hours:

8 AM – 5 PM EST, Monday‑Friday.

• Review clinical information from providers to determine Medical Necessity.
• Apply managed care contracting, medical necessity, and clinical protocols to authorize services.
• Ensure compliance with contractual, regulatory, and payer requirements.
• Enter accurate data into the claims system for payment processing.

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

• Licensed Clinical Social Worker (LCSW) – State license (Virginia or North Carolina).
• Licensed Professional Counselor (LPC) – State license (Virginia or North Carolina).
• Licensed Marriage and Family Therapist (LMFT) – State license (Virginia or North Carolina).
• Registered Nurse (RN) – Valid state license (Virginia or North Carolina, single or multi‑state).

• At least 2 years of behavioral health experience (required).
• At least 1 year of case management experience (required).
• Experience in a residential facility is preferred.

• Position Status:
  Full‑time, permanent (40 hours/week).
• Work Shift:
  
  First (Days).
• City/State:
  Winchester, VA.

• Medical, Dental, Vision plans.
• Adoption, Fertility, and Surrogacy reimbursement up to $10,000.
• Paid Time Off, Sick Leave, and Parental & Family Caregiver Leave.
• Emergency Backup Care, Disability and Critical Illness plans.
• Life Insurance and 401(k)/403(b) with employer match.
• Tuition Assistance – $5,250/year and discounted opportunities.
• Student Debt Pay Down up to $10,000.
• Reimbursement for certifications and access to CEUs.
• Pet Insurance and Legal Resources Plan.
• Annual discretionary bonus opportunity.

Sentara Health is an equal‑opportunity employer and values diversity, inclusion, and belonging.