Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN for Weekends- Remote in VA and NC!

City/State

Overview

Work Shift

Status: Full-time, permanent position (40 hours)

Work hours: Flexible dayshift; Can start from 6am to 9am EST for a 10 hour shift (Thursday to Sunday);

Location: Fully remote in Virginia OR Northeast North Carolina.

Job Description Summary:

• 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.

Required qualifications:

• Masters Degree in Social Work or Counseling Field -or- Bachelors Degree in Nursing REQUIRED

• Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC) or Licensed Marriage and Family Therapist (LMFT) or Registered Nurse License (RN) current license for the state of Virginia REQUIRED

• LMHP- S, LMHP-R may be considered if actively working towards licensure and prior experience is present

• 2 Years 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

Preferred qualifications:

• 1 Year Case Management preferred

Job Summary

Qualifications:

Skills

Sentara Healthcare 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.

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission "to improve health every day," this is a tobacco-free environment.